Individual
JOHN MICHAEL EASON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
200 MEDICAL VILLAGE DR, EDGEWOOD, KY 41017-3408
(859) 301-5901
(859) 301-5940
Mailing address
2300 CHAMBER CENTER DR, SUITE 200, LAKESIDE PARK, KY 41017-1686
(859) 301-5901
(859) 301-5940
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
3196
KY
1041C0700X
Clinical Social Worker
3196
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0155189
—
OH
05
—
7100374360
—
KY
Enumeration date
10/07/2015
Last updated
04/27/2016
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