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General NPI Number Information
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NPI Number | 1841018744
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Entity Type | Individual
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Provider Name | JUSTIN EASTLAND LMSW
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Gender | Male
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Dates
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Enumeration Date | 09/30/2024
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Last Update Date | 09/30/2024
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Provider Practice Location Address
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Address Line | 22480 DUFF LN
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City | MIDDLETON
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State | ID
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Zip | 83644-6041
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Country | US
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Telephone | 310-903-6814
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Fax |
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Provider Business Mailing Address
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Address Line | 10712 W CRUSER DR
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City | BOISE
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State | ID
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Zip | 83709-0209
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Country | US
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Telephone | 310-903-6814
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State | ID
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