MEDICARE: MS. KYRA EDEN HOUSE LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LH60160833	WA

General Provider Information

NPI Number	:	1598076689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KYRA EDEN HOUSE LMHC

Provider Business Mailing Address
First Line	:	1220 BRAWNE AVE NW
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98502-4806
Country	:	US
Telephone Number	:	360-250-5831
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 STATE AVE NE STE A
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98501-1131
Country	:	US
Telephone Number	:	360-250-5831
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2010
Last Update Date	:	06/23/2010

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