Provider Demographics
NPI:1912089889
Name:EASTERLY, HEIDI M (LMFT)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:M
Last Name:EASTERLY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4216 FLAGSTAFF COVE
Mailing Address - Street 2:HARVEST COUNSELING GROUP INC
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-4417
Mailing Address - Country:US
Mailing Address - Phone:260-485-4357
Mailing Address - Fax:260-485-4357
Practice Address - Street 1:4216 FLAGSTAFF COVE
Practice Address - Street 2:HARVEST COUNSELING GROUP INC
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815-4417
Practice Address - Country:US
Practice Address - Phone:260-485-4357
Practice Address - Fax:260-485-4357
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35001427A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
373674OtherVALUE OPTIONS
000000191132OtherANTHEM