Provider Demographics
NPI:1104949437
Name:EASTERBROOK, MATTHEW ALAN SR (BA)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:ALAN
Last Name:EASTERBROOK
Suffix:SR
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1116 E LUGONIA AVE
Mailing Address - Street 2:APT D
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-2689
Mailing Address - Country:US
Mailing Address - Phone:909-307-0604
Mailing Address - Fax:
Practice Address - Street 1:1330 N INDIAN CANYON DR
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4880
Practice Address - Country:US
Practice Address - Phone:760-322-9065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)