Provider Demographics
NPI:1134967441
Name:STONEWELL BEHAVIORAL PLLC
Entity type:Organization
Organization Name:STONEWELL BEHAVIORAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:N
Authorized Official - Last Name:IGBUDU
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:817-903-4794
Mailing Address - Street 1:4907 GEORGIANA LN
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-4340
Mailing Address - Country:US
Mailing Address - Phone:817-903-4794
Mailing Address - Fax:
Practice Address - Street 1:4907 GEORGIANA LN
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-4340
Practice Address - Country:US
Practice Address - Phone:817-903-4794
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty