Provider Demographics
NPI:1194396259
Name:EASTES, RONALD (MA, LMFT-S)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:EASTES
Suffix:
Gender:M
Credentials:MA, LMFT-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1698 OLD LEBANON RD
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-3319
Mailing Address - Country:US
Mailing Address - Phone:270-465-3561
Mailing Address - Fax:
Practice Address - Street 1:1911 CAMPBELLSVILLE RD
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:KY
Practice Address - Zip Code:42743-7758
Practice Address - Country:US
Practice Address - Phone:270-465-3561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY248125106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist