Provider Demographics
NPI:1619678497
Name:EASON, LISA GAIL
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:GAIL
Last Name:EASON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 WINSTON WAY STE 3
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-4991
Mailing Address - Country:US
Mailing Address - Phone:270-572-9014
Mailing Address - Fax:
Practice Address - Street 1:102 WINSTON WAY STE 3
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-4991
Practice Address - Country:US
Practice Address - Phone:270-465-0078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-17
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical