Provider Demographics
NPI:1669106530
Name:EASON, JEROME LINDELL (LCMHC, LASUDC)
Entity type:Individual
Prefix:
First Name:JEROME
Middle Name:LINDELL
Last Name:EASON
Suffix:
Gender:M
Credentials:LCMHC, LASUDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 W 2710 SOUTH CIR STE 202A
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-7205
Mailing Address - Country:US
Mailing Address - Phone:435-652-0645
Mailing Address - Fax:
Practice Address - Street 1:169 W 2710 SOUTH CIR STE 202A
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7205
Practice Address - Country:US
Practice Address - Phone:435-760-0133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-14
Last Update Date:2022-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8648870-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty