Provider Demographics
NPI:1154176360
Name:EASTMAN, MELODY ANNE
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:ANNE
Last Name:EASTMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2657 PACIFIC HIGHLANDS CT
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98248-8610
Mailing Address - Country:US
Mailing Address - Phone:360-927-6751
Mailing Address - Fax:
Practice Address - Street 1:214 N COMMERCIAL ST STE 102
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4410
Practice Address - Country:US
Practice Address - Phone:360-393-5114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health