Provider Demographics
NPI:1982395448
Name:EASTER, JOHNATHON RAESHON
Entity Type:Individual
Prefix:
First Name:JOHNATHON
Middle Name:RAESHON
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 1:20971 E SMOKY HILL RD STE 102
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-5187
Mailing Address - Country:US
Mailing Address - Phone:720-961-8539
Mailing Address - Fax:
Practice Address - Street 1:20971 E SMOKY HILL RD STE 102
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80015-5187
Practice Address - Country:US
Practice Address - Phone:720-961-8539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician