Provider Demographics
NPI:1205197498
Name:EASTER, GEORGE ALLEN
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:ALLEN
Last Name:EASTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11140 STRATFORD DR
Mailing Address - Street 2:607
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-7245
Mailing Address - Country:US
Mailing Address - Phone:405-306-8733
Mailing Address - Fax:
Practice Address - Street 1:11140 STRATFORD DR
Practice Address - Street 2:607
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-7245
Practice Address - Country:US
Practice Address - Phone:405-306-8733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-04
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst