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General NPI Number Information
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NPI Number | 1902395064
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Entity Type | Organization
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Legal Business Name | EDEN DEVELOPMENT NETWORK
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Dates
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Enumeration Date | 05/04/2018
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Last Update Date | 06/23/2025
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Provider Practice Location Address
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Address Line | 507 WOOD ST
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City | CHICAGO HEIGHTS
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State | IL
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Zip | 60411-1625
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Country | US
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Telephone | 708-918-3351
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Fax |
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Provider Business Mailing Address
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Address Line | REGINA MCCLURE 20650 S. CICERO AVENUE, #613
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City | MATTESON
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State | IL
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Zip | 60443
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Country | US
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Telephone | 708-918-3351
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/EXECUTIVE DIRECTOR
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Name | REGINA B MCCLURE
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Credential | LCPC
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Telephone | 708-918-3351
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TM1800X
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Taxonomy Name | Intellectual & Developmental Disabilities Psychologist
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License Number |
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License Number State | IL
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Taxonomy #2
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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 #3
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180006064
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License Number State | IL
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