Provider Demographics
NPI:1477199784
Name:AIRBETS, EDEN LOUISE
Entity type:Individual
Prefix:
First Name:EDEN
Middle Name:LOUISE
Last Name:AIRBETS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EDEN
Other - Middle Name:L
Other - Last Name:HANBACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1217 S EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-3311
Mailing Address - Country:US
Mailing Address - Phone:989-667-9661
Mailing Address - Fax:
Practice Address - Street 1:1217 S EUCLID AVE
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-3311
Practice Address - Country:US
Practice Address - Phone:989-667-9661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011022811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical