Provider Demographics
NPI:1235889288
Name:EASTHAM, TERRAN
Entity type:Individual
Prefix:
First Name:TERRAN
Middle Name:
Last Name:EASTHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TERRAN
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 16331
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-6331
Mailing Address - Country:US
Mailing Address - Phone:406-414-9623
Mailing Address - Fax:
Practice Address - Street 1:2601 S 3RD ST W
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-1143
Practice Address - Country:US
Practice Address - Phone:406-414-9623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-24
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCSW-LIC-715091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical