Provider Demographics
NPI:1275322851
Name:FRASER, EDEN (RBT)
Entity type:Individual
Prefix:
First Name:EDEN
Middle Name:
Last Name:FRASER
Suffix:
Gender:
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1972 INNERBELT BUSINESS CENTER DR
Mailing Address - Street 2:
Mailing Address - City:OVERLAND
Mailing Address - State:MO
Mailing Address - Zip Code:63114-5760
Mailing Address - Country:US
Mailing Address - Phone:314-649-7776
Mailing Address - Fax:415-406-3316
Practice Address - Street 1:1972 INNERBELT BUSINESS CENTER DR
Practice Address - Street 2:
Practice Address - City:OVERLAND
Practice Address - State:MO
Practice Address - Zip Code:63114-5760
Practice Address - Country:US
Practice Address - Phone:314-649-7776
Practice Address - Fax:415-406-3316
Is Sole Proprietor?:No
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MORBT-24-372758106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician