Healthcare Provider Details

I. General information

NPI: 1689082018
Provider Name (Legal Business Name): TERESA JEAN EASTON MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2014
Last Update Date: 07/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1563 N MAIN ST SUITE 202
FALL RIVER MA
02720-2983
US

IV. Provider business mailing address

15140 HIGHWAY 104 N
LEXINGTON TN
38351-6352
US

V. Phone/Fax

Practice location:
  • Phone: 508-324-1060
  • Fax:
Mailing address:
  • Phone: 731-293-3975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: