Provider Demographics
NPI:1285890707
Name:EASTERLY, LESLIE JANE (MA, LPC, LMHP)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:JANE
Last Name:EASTERLY
Suffix:
Gender:F
Credentials:MA, LPC, LMHP
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:JANE
Other - Last Name:SIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2245 ILLINOIS ST
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:NE
Mailing Address - Zip Code:69162-1440
Mailing Address - Country:US
Mailing Address - Phone:308-254-1114
Mailing Address - Fax:308-254-1114
Practice Address - Street 1:2245 ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:NE
Practice Address - Zip Code:69162-1440
Practice Address - Country:US
Practice Address - Phone:308-254-1114
Practice Address - Fax:308-254-1114
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3036101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health