Healthcare Provider Details

I. General information

NPI: 1548026925
Provider Name (Legal Business Name): MICHAEL EDWARD EASLEY LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2024
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 N 7TH ST STE 6
SPEARFISH SD
57783-2710
US

IV. Provider business mailing address

115 N 7TH ST STE 6
SPEARFISH SD
57783-2710
US

V. Phone/Fax

Practice location:
  • Phone: 605-645-0100
  • Fax:
Mailing address:
  • Phone: 605-645-0100
  • Fax: 605-717-1009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC20952
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: