Provider Demographics
NPI:1730668260
Name:EASTERLING, JESSICA BOYD (LPC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:BOYD
Last Name:EASTERLING
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54306 JIM STUART RD
Mailing Address - Street 2:
Mailing Address - City:ANGIE
Mailing Address - State:LA
Mailing Address - Zip Code:70426-3364
Mailing Address - Country:US
Mailing Address - Phone:985-516-4835
Mailing Address - Fax:
Practice Address - Street 1:54306 JIM STUART RD
Practice Address - Street 2:
Practice Address - City:ANGIE
Practice Address - State:LA
Practice Address - Zip Code:70426-3364
Practice Address - Country:US
Practice Address - Phone:985-516-4835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3618101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor