Mandy Elaine Ethridge, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

67716 Issued in TX

Practice address

111 N Wall St Unit 1295
Belton, TX 76513-0128

Phone

(254) 535-3688

Fax

(800) 747-3074

NPI assigned

Mar 13, 2013

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1363132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726704000000",
    "number": "1790026946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1295",
            "city": "BELTON",
            "state": "TX",
            "postal_code": "765135295",
            "telephone_number": "254-535-3688",
            "fax_number": "800-747-3074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 N WALL ST UNIT 1295",
            "city": "BELTON",
            "state": "TX",
            "postal_code": "765130128",
            "telephone_number": "254-535-3688",
            "fax_number": "800-747-3074"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "80 Morgans Point Rd",
            "address_purpose": "LOCATION",
            "city": "Belton",
            "state": "TX",
            "postal_code": "765136865",
            "country_code": "US",
            "telephone_number": "254-535-3688",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ETHRIDGE",
        "first_name": "MANDY",
        "middle_name": "ELAINE",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-03-13",
        "last_updated": "2024-09-19",
        "certification_date": "2024-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "67716",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Belton, TX
• Providers in Belton, TX by specialty
• Professional Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.