Active NPI
Larry D. Etter, PH.D, LPC
- Mental Health Counselor
- San Antonio, TX
National Provider Identifier
1609885391
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 12043
- Practice address
- 10010 San Pedro Ave
# 610
San Antonio, TX 78216-3862 - Phone
- (210) 414-3259
- Fax
- (210) 222-8030
- NPI assigned
- Aug 5, 2006
- Last updated
- Jul 21, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 12043 | TX | Primary |
Addresses
Primary practice location
10010 San Pedro Ave
# 610
San Antonio, TX 78216-3862
Mailing address
10010 San Pedro Ave
# 610
San Antonio, TX 78216-3862
Phone (210) 414-3259
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1485104-05 | Medicaid | TX | |
| 148510402 | Medicaid | TX | |
| 148510401 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12043 | TX | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Third Day Counseling Services, PLLC | Mental Health | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Mental Health Counselor
- San Antonio, TX
- NPI 1144239849
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154736000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1311206400000",
"number": "1609885391",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10010 SAN PEDRO AVE",
"address_2": "# 610",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782163862",
"telephone_number": "210-414-3259",
"fax_number": "210-222-8030"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10010 SAN PEDRO AVE",
"address_2": "# 610",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782163862",
"telephone_number": "210-414-3259",
"fax_number": "210-222-8030"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ETTER",
"first_name": "LARRY",
"middle_name": "D.",
"name_prefix": "Dr.",
"credential": "PH.D, LPC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-05",
"last_updated": "2011-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "TX",
"license": "12043",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1485104-05",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "148510402",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "148510401",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Antonio, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.