1619024148 NPI number — MR. RONALD JAMES EASTMAN MED LMHC CGP

Table of content: MR. RONALD JAMES EASTMAN MED LMHC CGP (NPI 1619024148)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619024148 NPI number — MR. RONALD JAMES EASTMAN MED LMHC CGP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EASTMAN
Provider First Name:
RONALD
Provider Middle Name:
JAMES
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MED LMHC CGP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619024148
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/15/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 14234
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPOKANE VALLEY
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99214-0234
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-456-2190
Provider Business Mailing Address Fax Number:
509-456-7371

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
607 S GOVERNMENT WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99224-1860
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-456-2190
Provider Business Practice Location Address Fax Number:
509-456-7371
Provider Enumeration Date:
01/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  LH00004530 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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