Healthcare Provider Details

I. General information

NPI: 1477672756
Provider Name (Legal Business Name): FAITH MEGAN EIDSON MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 04/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1939 FRONTAGE RD STE A SUITE 200
SIERRA VISTA AZ
85635-4638
US

IV. Provider business mailing address

2183 COPPER SKY DR
SIERRA VISTA AZ
85635-6950
US

V. Phone/Fax

Practice location:
  • Phone: 520-452-9784
  • Fax:
Mailing address:
  • Phone: 520-452-9784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801085600
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-12459
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: