1043332836 NPI number — MR. JOE AARON EASTHAM L.M.F.T, L.P.C.

Table of content: MR. JOE AARON EASTHAM L.M.F.T, L.P.C. (NPI 1043332836)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043332836 NPI number — MR. JOE AARON EASTHAM L.M.F.T, L.P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EASTHAM
Provider First Name:
JOE
Provider Middle Name:
AARON
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
L.M.F.T, L.P.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043332836
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4686 BRISTOL TRACE TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KELLER
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76248-6947
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-300-1590
Provider Business Mailing Address Fax Number:
817-886-0504

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 S CENTER ST
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76010-7139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-300-1590
Provider Business Practice Location Address Fax Number:
817-656-1243
Provider Enumeration Date:
04/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  18235 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: 5069 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 178746701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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