Provider Demographics
NPI:1861528390
Name:STONEBRIDGE BEHAVIORAL HEALTH, P.A.
Entity type:Organization
Organization Name:STONEBRIDGE BEHAVIORAL HEALTH, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:L
Authorized Official - Last Name:COVERSTONE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:713-827-1510
Mailing Address - Street 1:13300 OLD BLANCO RD STE 180
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-7738
Mailing Address - Country:US
Mailing Address - Phone:713-827-1510
Mailing Address - Fax:
Practice Address - Street 1:13300 OLD BLANCO RD STE 180
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-7738
Practice Address - Country:US
Practice Address - Phone:432-394-4664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX181349501Medicaid
TX181349501Medicaid