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NPI Code Detail

MEDICARE: ALLEN ROY EASLEY

MEDICARE: ALLEN ROY EASLEY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor

General Provider Information

NPI Number : 1538769310
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALLEN ROY EASLEY
Provider Business Mailing Address
First Line : 1905 CONTINENTAL PL
Second Line :
City : MOUNT VERNON
State : WA
Zip : 98273-5633
Country : US
Telephone Number : 360-755-6406
Fax Number :
Provider Business Practice Location Address
First Line : 1905 CONTINENTAL PL
Second Line :
City : MOUNT VERNON
State : WA
Zip : 98273-5633
Country : US
Telephone Number : 360-755-6406
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/29/2020
Last Update Date : 10/29/2020

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Directions to “ ALLEN ROY EASLEY ” Practice Location

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