Joe Michael Waller, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Practice address

703 W Patten St
Mineola, TX 75773-1541

Phone

(903) 569-5409

Fax

(900) 353-5738

NPI assigned

Jan 20, 2021

Last updated

Aug 15, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1611100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660521600000",
    "number": "1790375103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2323 W FRONT ST",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757027704",
            "telephone_number": "903-535-7421",
            "fax_number": "903-535-7384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "703 W PATTEN ST",
            "city": "MINEOLA",
            "state": "TX",
            "postal_code": "757731541",
            "telephone_number": "903-569-5409",
            "fax_number": "900-353-5738"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2323 W Front St",
            "address_purpose": "LOCATION",
            "city": "Tyler",
            "state": "TX",
            "postal_code": "757027747",
            "country_code": "US",
            "telephone_number": "903-535-7421",
            "fax_number": "903-535-7384",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLER",
        "first_name": "JOE",
        "middle_name": "MICHAEL",
        "name_prefix": "Mr.",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-01-20",
        "last_updated": "2022-08-15",
        "certification_date": "2022-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "101YS0200X",
            "taxonomy_group": "",
            "desc": "Counselor, School",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "419100901",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "http://www.andrewscenter.com/home/",
            "affiliation": "N",
            "endpointDescription": "Andrews Center Website",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "To inform clients of services available and to inform how to request an appointment",
            "address_1": "2323 W Front St",
            "city": "Tyler",
            "state": "TX",
            "country_code": "US",
            "postal_code": "757027747",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2022; 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.