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General NPI Number Information
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NPI Number | 1366564064
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Entity Type | Organization
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Legal Business Name | STONEGATE BEHAVIORAL HEALTH, P.C.
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 4686 BRISTOL TRACE TRL
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City | KELLER
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State | TX
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Zip | 76248-6947
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Country | US
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Telephone | 817-300-1590
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Fax | 817-886-0504
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Provider Business Mailing Address
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Address Line | PO BOX 60722
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City | FORT WORTH
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State | TX
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Zip | 76115-6722
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Country | US
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Telephone | 817-300-1590
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Fax | 817-886-0504
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. JOE AARON EASTHAM
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Credential | L.M.F.T., L.P.C.
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Telephone | 817-300-1590
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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