Doctor Name: | MR. JACKIE JOE EASTMAN |
NPI Number: | 1063616183 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.ED. |
License Number: | |
Business Practice Address: | 2530 S. Commerce Bldg. C Ardmore, OK - 73401 |
Business Phone Number: | 5802265048 |
Business Fax Number: | 5802263569 |
Mailing Address: | 2530 S. Commerce, Bldg. C ARDMORE |
State: | OK |
Postal Code: | 73401 |
Phone Number: | 5802265048 |
Fax Number: | 5802263569 |
NPI Enumeration Date: | 06/13/2007 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |