MEDICARE: MALLIE EASTERLIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	1478	TN

General Provider Information

NPI Number	:	1245728369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALLIE EASTERLIN

Provider Business Mailing Address
First Line	:	4235 HILLSBORO PIKE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37215-3344
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4235 HILLSBORO PIKE STE 330
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37215-3344
Country	:	US
Telephone Number	:	615-905-6718
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2018
Last Update Date	:	03/09/2021

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Directions to “ MALLIE EASTERLIN ” Practice Location

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