Provider Demographics
NPI:1043332836
Name:EASTHAM, JOE AARON (LMFT, LPC)
Entity Type:Individual
Prefix:MR
First Name:JOE
Middle Name:AARON
Last Name:EASTHAM
Suffix:
Gender:M
Credentials:LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4686 BRISTOL TRACE TRL
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-6947
Mailing Address - Country:US
Mailing Address - Phone:817-300-1590
Mailing Address - Fax:817-886-0504
Practice Address - Street 1:301 S CENTER ST
Practice Address - Street 2:SUITE 500
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-7139
Practice Address - Country:US
Practice Address - Phone:817-300-1590
Practice Address - Fax:817-656-1243
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2021-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18235101YM0800X
TX5069106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178746701Medicaid