Most Relevant Information
Provider Data
| NPI Number: | 1003579723 |
| Provider Name: | MARJORIE EASTLACK |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 10/19/2021 |
| Last Updated: | 02/06/2023 |
Provider Practice Location
8501 WADE BLVD STE 1250
FRISCO
TX
750345894
Practice Location Phone/Fax
| Phone: | 9723128733 |
| Fax: |
Provider Mailing Location
6105 WINDCOM CT STE 400
PLANO
TX
750939003
Provider Mailing Phone/Fax
| Phone: | 9723128733 |
| Fax: | 9723784747 |