Eden Davis, BCBA, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

73850 Issued in TX

Practice address

204 Front Street
Quanah, TX 79252

Phone

(254) 315-4829

NPI assigned

Jan 11, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1484092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589760000000",
    "number": "1912443284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 FRONT STREET",
            "city": "QUANAH",
            "state": "TX",
            "postal_code": "79252",
            "telephone_number": "254-315-4829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 FRONT STREET",
            "city": "QUANAH",
            "state": "TX",
            "postal_code": "79252",
            "telephone_number": "254-315-4829"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3501 Sheppard Access Rd",
            "address_purpose": "LOCATION",
            "city": "Wichita Falls",
            "state": "TX",
            "postal_code": "763064235",
            "country_code": "US",
            "telephone_number": "940-782-9979",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "EDEN",
        "credential": "BCBA, LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-01-11",
        "last_updated": "2020-05-18",
        "certification_date": "2020-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "TX",
            "license": "73850",
            "primary": true
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "TX",
            "license": "1-16-24503",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Robert Baucum, DDS
• Stacie Magdelena Blodgett
• Danica Erin Call, PT, MPT, CLT
• County of Hardeman (Hardeman County EMS)
• Covenant Care Center of Quanah, LLC (Quanah Nursing Center)
• Eric Robert Estrada, M.D
• Fara Faythe Garza, MSN, RN, FNP-C
• Vickie Hammack, RN
• Hardeman County Lifeline
• Hardeman County Memorial Hosp (Hardeman County Memorial Hospital)

• Mental Health Counselor in Quanah, TX
• Providers in Quanah, TX by specialty
• Mental Health Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2020; 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.