Provider Demographics
NPI:1548071715
Name:JEFFERS, EDEN RAE
Entity type:Individual
Prefix:
First Name:EDEN
Middle Name:RAE
Last Name:JEFFERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 LAKEVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:TENNESSEE RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37178-5106
Mailing Address - Country:US
Mailing Address - Phone:931-401-6646
Mailing Address - Fax:
Practice Address - Street 1:10264 WADDELL CIR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92124-2934
Practice Address - Country:US
Practice Address - Phone:931-449-3891
Practice Address - Fax:833-515-2618
Is Sole Proprietor?:No
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst