MEDICARE: EDEN COUNSELING SERVICES

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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1649374398
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDEN COUNSELING SERVICES

Provider Business Mailing Address
First Line	:	20253 REDWOOD RD
Second Line	:	#A
City	:	CASTRO VALLEY
State	:	CA
Zip	:	94546
Country	:	US
Telephone Number	:	510-247-9831
Fax Number	:	510-247-9825

Provider Business Practice Location Address
First Line	:	20253 REDWOOD RD
Second Line	:	#A
City	:	CASTRO VALLEY
State	:	CA
Zip	:	94546-4331
Country	:	US
Telephone Number	:	510-247-9831
Fax Number	:	510-247-9825

Authorized Official
Title or Position	:	DIRECTOR
Name	:	CAROLYN WESTON
Credential	:	PHD
Telephone Number	:	510-247-9831

Provider Enumeration Date	:	09/12/2006
Last Update Date	:	08/22/2020

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