Individual provider Active NPI

Joseph Robert Eatherly, LPC

  • Professional Counselor
  • San Antonio, TX
National Provider Identifier
1720303134
Registry record updated May 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
98464 Issued in TX
Practice address
540 Oak Centre Dr Ste 205
San Antonio, TX 78258-4767
Phone
(844) 824-8775
NPI assigned
Mar 30, 2010
Last updated
May 27, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 27, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X NU
Professional Counselor 101YP2500X 5004 OK
Professional Counselor 101YP2500X 98464 TX Primary

Addresses

Primary practice location

540 Oak Centre Dr Ste 205
San Antonio, TX 78258-4767

Mailing address

49500 CR E 1600
Stratford, OK 74872
Phone (580) 320-5633

Other practice location 1

108 W Main St
Tishomingo, OK 73460-1723
Phone (580) 371-3019

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK, TX2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20250422000876 OK Practitioner - Mental Health Counselor 9931624004 Reassigns benefits to 1 organization
I20250603002228 TX Practitioner - Mental Health Counselor 9931624004 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Progressive Behavioral Health, PLLCGroup PAC ID 4486794906, 366 clinicians

Practice addresses (Care Compare)

540 Oak Centre Dr
Suite 205
San Antonio, TX 78258-4767
Phone (844) 824-8775

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Mosaic Medbill LLC Professional CurrentSince Apr 18, 2025 Accepting new patients
Emdr Solutions LLC Current Accepting new patients
Progressive Behavioral Health, PLLC Professional CurrentSince May 30, 2025 Accepting new patients
Mosaic Health Foundation PastSince Oct 15, 2023 Accepting new patients

Locations

1013 15th Ave NW
Ardmore, OK 73401
Phone (580) 238-4277

5350 S Western Ave
Ste 215
Oklahoma City, OK 73109
Phone (405) 518-0082

308 S Friendswood Dr
Ste 200
Friendswood, TX 77546
Phone (253) 346-0386

12505 Memorial Dr
Ste 230
Houston, TX 77024
Phone (210) 858-9078

23051 Kingwood Place Dr
Ste 110
Kingwood, TX 77339
Phone (281) 374-4500

540 Oak Centre Dr
Ste 205
San Antonio, TX 78258
Phone (210) 705-5001

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1269907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748304000000",
    "number": "1720303134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "49500 CR E 1600",
            "city": "STRATFORD",
            "state": "OK",
            "postal_code": "74872",
            "telephone_number": "580-320-5633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "540 OAK CENTRE DR STE 205",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782584767",
            "telephone_number": "844-824-8775"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "108 W Main St",
            "address_purpose": "LOCATION",
            "city": "Tishomingo",
            "state": "OK",
            "postal_code": "734601723",
            "country_code": "US",
            "telephone_number": "580-371-3019",
            "fax_number": "580-371-0138",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EATHERLY",
        "first_name": "JOSEPH",
        "middle_name": "ROBERT",
        "name_prefix": "Mr.",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-03-30",
        "last_updated": "2025-05-27",
        "certification_date": "2025-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OK",
            "license": "5004",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "98464",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.