Eagle Therapeutic Services LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

EAGLE THERAPEUTIC SERVICES LLC

Doing business as

Eagle Therapeutic Services LLC

Practice address

1565 Ebenezer Rd Ste 102
Rock Hill, SC 29732-2494

Phone

(980) 643-1148

NPI assigned

Aug 25, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Paul Maurice Ewing, LPCNPI 1740774736

Title

Owner/Manager

Phone

(980) 643-1148

Specialties & licenses 1

Addresses

Other names 1

• Eagle Therapeutic Services LLC Doing business as

Tax ID family

Eagle Therapeutic Services LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Eagle Therapeutic Services PLLC

  • Community/Behavioral Health Agency
  • Charlotte, NC
  • NPI 1295424075
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Paul Maurice Ewing

  • Mental Health Counselor
  • Charlotte, NC
  • NPI 1740774736
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1629849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630368000000",
    "number": "1083381297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "677 NANNYBERRY LN",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280259003",
            "telephone_number": "336-772-5711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1565 EBENEZER RD STE 102",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "297322494",
            "telephone_number": "980-643-1148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGLE THERAPEUTIC SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-25",
        "last_updated": "2021-08-31",
        "certification_date": "2021-08-31",
        "status": "A",
        "authorized_official_last_name": "EWING",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "MAURICE",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "980-643-1148",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eagle Therapeutic Services LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brianna Dyer, LMSW
• Logan G Dyer, L.AC.
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• E and S Cares
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• Eagle's Nest Counseling, LLC
• Ear Nose Throat & Audiology Associates
• Ebenezer Road, LLC (Brookdale Ebenezer Road)
• Ebenezer Senior Services, LLC (Agape Rehabilitation of Rock Hill)
• Travis Eckman

• Mental Health Clinic/Center (Including Community Mental Health Center) in Rock Hill, SC
• Providers in Rock Hill, SC by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.