| Doctor Name: | MRS. TAMMY ANN EASTHAM |
| NPI Number: | 1720335540 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ED. S. |
| License Number: | 12004920 |
| Business Practice Address: | 200 Center St Moriarty, NM - 87035 |
| Business Phone Number: | 5058324421 |
| Business Fax Number: | 5058324472 |
| Mailing Address: | Po Box 683, MORIARTY |
| State: | NM |
| Postal Code: | 870350683 |
| Phone Number: | 2085507559 |
| Fax Number: | |
| NPI Enumeration Date: | 08/10/2012 |
| NPI Last Update Date: | 08/10/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TS0200X |
| License Number: | 12004920 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |