Provider Demographics
NPI:1386989317
Name:EASTIN, RACHELLE (LCMHC)
Entity type:Individual
Prefix:MRS
First Name:RACHELLE
Middle Name:
Last Name:EASTIN
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:MRS
Other - First Name:RACHELLE
Other - Middle Name:
Other - Last Name:BUCKNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MHC-I
Mailing Address - Street 1:240 N. EAST PROMONTORY #200
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025
Mailing Address - Country:US
Mailing Address - Phone:801-510-1434
Mailing Address - Fax:801-218-3501
Practice Address - Street 1:240 N. EAST PROMONTORY #200
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025
Practice Address - Country:US
Practice Address - Phone:801-510-1434
Practice Address - Fax:801-218-3501
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-03
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health