Eidolon Therapeutic Counseling LLC

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

Legal business name

EIDOLON THERAPEUTIC COUNSELING LLC

Practice address

10 Park Ave
New York, NY 10016-4338

Phone

(646) 460-2543

NPI assigned

Apr 19, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Fredbrick Bush, LCSW

Title

Owner

Phone

(646) 460-2543

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1681862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681862400000",
    "number": "1295422459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 PARK AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100164338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 PARK AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100164338",
            "telephone_number": "646-460-2543"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EIDOLON THERAPEUTIC COUNSELING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-19",
        "last_updated": "2023-04-19",
        "certification_date": "2023-04-19",
        "status": "A",
        "authorized_official_last_name": "BUSH",
        "authorized_official_first_name": "FREDBRICK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "646-460-2543",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole Rose Eiden, MD
• Mahyar Eidgah, M.D.
• Laura D'Nell Eidlitz, PHD
• Daniel Eidman, M.D.
• Hannah Eidman
• Andrew Michael Eig, PH.D.
• Dawn Elaine Eig
• Michael E Eigen
• Randall Eiger, LCSW
• Katherine Eiges, PHD

• Adult Mental Health Clinic/Center in New York, NY
• Providers in New York, NY by specialty
• Adult Mental Health Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.