Provider Demographics
NPI:1649680885
Name:EASTON, AMANDA BROOKE (CRC, LCPC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:BROOKE
Last Name:EASTON
Suffix:
Gender:F
Credentials:CRC, LCPC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:BROOKE
Other - Last Name:TASHJIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRC, LCPC
Mailing Address - Street 1:1727 S INDIANA AVE
Mailing Address - Street 2:APARTMENT 324
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-1390
Mailing Address - Country:US
Mailing Address - Phone:312-622-8617
Mailing Address - Fax:
Practice Address - Street 1:300 W ADAMS ST
Practice Address - Street 2:SUITE 514
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-5101
Practice Address - Country:US
Practice Address - Phone:312-578-9990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-28
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180008978101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional