Provider Demographics
NPI:1194213447
Name:EAST, MISTY DENILE (LCSW)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:DENILE
Last Name:EAST
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MISTY
Other - Middle Name:
Other - Last Name:MCMORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8211 S DREXEL AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-5456
Mailing Address - Country:US
Mailing Address - Phone:773-682-0704
Mailing Address - Fax:
Practice Address - Street 1:8211 S DREXEL AVE APT 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-5456
Practice Address - Country:US
Practice Address - Phone:773-682-0704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0151891041C0700X
TX697231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical