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NPI Code Detail

MEDICARE: MR. JOSEPH ROBERT EATHERLY LPC

MEDICARE: MR. JOSEPH ROBERT EATHERLY LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor
2101YP2500XProfessional Counselor5004OK
3101YP2500XProfessional Counselor98464TX

General Provider Information

NPI Number : 1720303134
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOSEPH ROBERT EATHERLY LPC
Provider Business Mailing Address
First Line : 49500 CR E 1600
Second Line :
City : STRATFORD
State : OK
Zip : 74872
Country : US
Telephone Number : 580-320-5633
Fax Number :
Provider Business Practice Location Address
First Line : 540 OAK CENTRE DR STE 205
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78258-4767
Country : US
Telephone Number : 844-824-8775
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2010
Last Update Date : 05/27/2025

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