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General NPI Number Information
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NPI Number | 1861214272
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Entity Type | Organization
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Legal Business Name | EDEN BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 10/28/2024
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 81 HARMONY LN
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City | ROMEOVILLE
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State | IL
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Zip | 60446-4296
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Country | US
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Telephone | 708-967-3092
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Fax |
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Provider Business Mailing Address
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Address Line | 81 HARMONY LN
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City | ROMEOVILLE
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State | IL
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Zip | 60446-4296
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Country | US
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Telephone | 708-967-3092
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | HIDAYAT SHAH
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Credential | LCSW
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Telephone | 708-967-3092
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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