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General NPI Number Information
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NPI Number | 1760787303
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Entity Type | Individual
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Provider Name | KATIE A EASTMAN LPC
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Gender | Female
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Dates
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Enumeration Date | 01/12/2011
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Last Update Date | 11/03/2014
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Provider Practice Location Address
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Address Line | 191 E. AGATE AVENUE
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City | GRANBY
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State | CO
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Zip | 80446
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Country | US
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Telephone | 970-531-0501
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Fax | 970-887-2293
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Provider Business Mailing Address
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Address Line | PO BOX 903
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City | GRAND LAKE
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State | CO
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Zip | 80447-0903
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Country | US
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Telephone | 970-531-0501
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Fax | 970-887-2293
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 11384
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License Number State | CO
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