Provider Demographics
NPI:1134867211
Name:EASTHAM, ARROW S (LAC)
Entity type:Individual
Prefix:
First Name:ARROW
Middle Name:S
Last Name:EASTHAM
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:ARROW
Other - Middle Name:S
Other - Last Name:CAZARE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1312 N MERIDIAN RD
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3095
Mailing Address - Country:US
Mailing Address - Phone:406-756-6453
Mailing Address - Fax:
Practice Address - Street 1:1312 N MERIDIAN RD
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3095
Practice Address - Country:US
Practice Address - Phone:406-756-6453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LAC-LIC-55625101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)