MEDICARE: KYNDA EDEN BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	BEH-001026	AZ

General Provider Information

NPI Number	:	1811590896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYNDA EDEN BCBA

Provider Business Mailing Address
First Line	:	2146 W HIGHLAND AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85015-4147
Country	:	US
Telephone Number	:	619-822-9721
Fax Number	:

Provider Business Practice Location Address
First Line	:	3033 N 44TH ST STE 210
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-7244
Country	:	US
Telephone Number	:	623-263-3885
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2020
Last Update Date	:	03/18/2026

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