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General NPI Number Information
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NPI Number | 1720303134
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Entity Type | Individual
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Provider Name | JOSEPH ROBERT EATHERLY LPC
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Gender | Male
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Dates
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Enumeration Date | 03/30/2010
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Last Update Date | 05/27/2025
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Provider Practice Location Address
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Address Line | 540 OAK CENTRE DR STE 205
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City | SAN ANTONIO
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State | TX
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Zip | 78258-4767
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Country | US
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Telephone | 844-824-8775
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Fax |
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Provider Business Mailing Address
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Address Line | 49500 CR E 1600
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City | STRATFORD
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State | OK
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Zip | 74872
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Country | US
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Telephone | 580-320-5633
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | 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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 5004
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 98464
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License Number State | TX
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