Healthcare Provider Details

I. General information

NPI: 1295645091
Provider Name (Legal Business Name): EDEN GILLUND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EDEN DEUTZ

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4539 N 22ND ST STE R
PHOENIX AZ
85016-4639
US

IV. Provider business mailing address

1150 W ALAMEDA DR STE 1
TEMPE AZ
85282-3361
US

V. Phone/Fax

Practice location:
  • Phone: 507-530-0945
  • Fax:
Mailing address:
  • Phone: 507-530-0945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLAC-24152
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: