Healthcare Provider Details

I. General information

NPI: 1902395064
Provider Name (Legal Business Name): EDEN DEVELOPMENT NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2018
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 WOOD ST
CHICAGO HEIGHTS IL
60411-1625
US

IV. Provider business mailing address

REGINA MCCLURE 20650 S. CICERO AVENUE, #613
MATTESON IL
60443
US

V. Phone/Fax

Practice location:
  • Phone: 708-918-3351
  • Fax:
Mailing address:
  • Phone: 708-918-3351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180006064
License Number StateIL

VIII. Authorized Official

Name: REGINA B MCCLURE
Title or Position: PRESIDENT/EXECUTIVE DIRECTOR
Credential: LCPC
Phone: 708-918-3351