Provider Demographics
NPI:1578819892
Name:STEVEN EASTMOND, LLC
Entity type:Organization
Organization Name:STEVEN EASTMOND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:EASTMOND
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-369-0053
Mailing Address - Street 1:789 BAMBERGER DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2181
Mailing Address - Country:US
Mailing Address - Phone:801-369-0053
Mailing Address - Fax:
Practice Address - Street 1:789 BAMBERGER DR
Practice Address - Street 2:SUITE A
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2181
Practice Address - Country:US
Practice Address - Phone:801-369-0053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT476632735011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty