Healthcare Provider Details

I. General information

NPI: 1326721481
Provider Name (Legal Business Name): DAWN HUTCHINS EASTMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DAWN HUTCHINS EASTMAN LMHC

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9301 INDIAN SCHOOL RD NE
ALBUQUERQUE NM
87112-2884
US

IV. Provider business mailing address

173 FORESTRIDGE LN
SUNRISE BEACH MO
65079-9268
US

V. Phone/Fax

Practice location:
  • Phone: 505-218-6383
  • Fax: 505-636-6338
Mailing address:
  • Phone: 920-716-6777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2023-0681
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: