Provider Demographics
NPI:1447931696
Name:EDENHART, KURSTYN (MED, LBS)
Entity type:Individual
Prefix:
First Name:KURSTYN
Middle Name:
Last Name:EDENHART
Suffix:
Gender:F
Credentials:MED, LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 WASHINGTON AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15017-2350
Mailing Address - Country:US
Mailing Address - Phone:412-319-7371
Mailing Address - Fax:
Practice Address - Street 1:429 WASHINGTON AVE STE 3
Practice Address - Street 2:
Practice Address - City:BRIDGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15017-2350
Practice Address - Country:US
Practice Address - Phone:412-319-7371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
BH007321103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician