Provider Demographics
NPI:1790982783
Name:STONEGATE BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:STONEGATE BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:EASTHAM
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, LPC
Authorized Official - Phone:817-300-1590
Mailing Address - Street 1:PO BOX 60722
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76115-6722
Mailing Address - Country:US
Mailing Address - Phone:817-300-1590
Mailing Address - Fax:817-886-0504
Practice Address - Street 1:4686 BRISTOL TRACE TRL
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-6947
Practice Address - Country:US
Practice Address - Phone:817-300-1590
Practice Address - Fax:817-886-0504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18235101YP2500X
TX5069106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty