Individual
DR. STANLEY BRENT EASTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ED.D.
Contact information
Practice address
320 OSUNA RD NE # H, SUITE 4, ALBUQUERQUE, NM 87107-5952
(505) 345-2778
(505) 345-2878
Mailing address
320 OSUNA RD NE # H, SUITE 4, ALBUQUERQUE, NM 87107-5952
(505) 345-2778
(505) 345-2878
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
NM 447
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
N0286
—
NM
Enumeration date
08/20/2006
Last updated
07/08/2007
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