Provider Demographics
NPI:1841660990
Name:DAVISSON, EDEN ELIZABETH (LCSW)
Entity type:Individual
Prefix:
First Name:EDEN
Middle Name:ELIZABETH
Last Name:DAVISSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10124
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78766-1124
Mailing Address - Country:US
Mailing Address - Phone:512-921-5566
Mailing Address - Fax:512-681-9214
Practice Address - Street 1:4534 W GATE BLVD
Practice Address - Street 2:SUITE 112
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1485
Practice Address - Country:US
Practice Address - Phone:512-921-5566
Practice Address - Fax:512-681-9214
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX545811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical