Provider Demographics
NPI:1548026925
Name:EASLEY, MICHAEL E (MSCMHC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:E
Last Name:EASLEY
Suffix:
Gender:M
Credentials:MSCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 826
Mailing Address - Street 2:
Mailing Address - City:SUNDANCE
Mailing Address - State:WY
Mailing Address - Zip Code:82729-0826
Mailing Address - Country:US
Mailing Address - Phone:307-290-0991
Mailing Address - Fax:
Practice Address - Street 1:115 N 7TH ST STE 6
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-2710
Practice Address - Country:US
Practice Address - Phone:605-645-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD20952101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health