Provider Demographics
NPI:1346834892
Name:SASSAMAN, EDEN (LAC, ATR-BC)
Entity type:Individual
Prefix:
First Name:EDEN
Middle Name:
Last Name:SASSAMAN
Suffix:
Gender:F
Credentials:LAC, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 NW 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-3424
Mailing Address - Country:US
Mailing Address - Phone:501-316-0937
Mailing Address - Fax:
Practice Address - Street 1:12001 COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:ALEXANDER
Practice Address - State:AR
Practice Address - Zip Code:72002-9303
Practice Address - Country:US
Practice Address - Phone:501-653-1012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool