Provider Demographics
NPI:1811597412
Name:EASTLING, MINDY MARIE (LCPC)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:MARIE
Last Name:EASTLING
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27240 DUTTON RD
Mailing Address - Street 2:
Mailing Address - City:BEECHER
Mailing Address - State:IL
Mailing Address - Zip Code:60401-5054
Mailing Address - Country:US
Mailing Address - Phone:219-384-5357
Mailing Address - Fax:
Practice Address - Street 1:27240 DUTTON RD
Practice Address - Street 2:
Practice Address - City:BEECHER
Practice Address - State:IL
Practice Address - Zip Code:60401-5054
Practice Address - Country:US
Practice Address - Phone:219-384-5357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-01
Last Update Date:2020-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180013079101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty