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General NPI Number Information
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NPI Number | 1073881561
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Entity Type | Individual
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Provider Name | JEFFREY EASTMAN LCPC
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Gender | Male
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Dates
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Enumeration Date | 12/12/2011
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Last Update Date | 03/01/2023
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Provider Practice Location Address
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Address Line | 2589 S FIVE MILE RD
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City | BOISE
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State | ID
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Zip | 83709-2325
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Country | US
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Telephone | 208-841-4837
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Fax |
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Provider Business Mailing Address
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Address Line | 2861 N MULE DEER WAY
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City | MERIDIAN
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State | ID
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Zip | 83646-7813
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Country | US
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Telephone | 208-509-0889
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC-4825
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 88523
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LCPC-5455
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License Number State | ID
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