Healthcare Provider Details

I. General information

NPI: 1790612034
Provider Name (Legal Business Name): PATRICK EASLEY MA, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5516 MALLARD DR
MATTESON IL
60443-1150
US

IV. Provider business mailing address

5516 MALLARD DR
MATTESON IL
60443-1150
US

V. Phone/Fax

Practice location:
  • Phone: 859-402-3828
  • Fax:
Mailing address:
  • Phone: 859-402-3828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178023125
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: