Shantale Etheridge

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

79090 Issued in TX

Practice address

6000 Brushy Creek Dr
Killeen, TX 76549-2001

Phone

(254) 519-8803

Fax

(254) 519-8805

NPI assigned

Nov 11, 2016

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

Enrolled in TX

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 1

Specialty

Mental Health Counselor

Education

Other, 2004

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Metroplex Clinic Physicians, Inc.

  • Urology Physician
  • Killeen, TX
  • NPI 1891730396

  Professional

  Medicare reassignment NPD

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

{
    "created_epoch": "1478822400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787788800000",
    "number": "1801338538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2403 W STAN SCHLUETER LOOP UNIT 690125",
            "city": "KILLEEN",
            "state": "TX",
            "postal_code": "765490206",
            "telephone_number": "254-499-2905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6000 BRUSHY CREEK DR",
            "city": "KILLEEN",
            "state": "TX",
            "postal_code": "765492001",
            "telephone_number": "254-519-8803",
            "fax_number": "254-519-8805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETHERIDGE",
        "first_name": "SHANTALE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-11-11",
        "last_updated": "2026-08-27",
        "certification_date": "2026-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "79090",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ernesto Malave MD PA
• John Raymond Ernst, PA-C
• Jennifer Esparza-Arismendi, NCC, LPC
• Kamia Stinson Esquerra, LPC
• Yaquelin Delcarmen Estrada, RBT
• Kimberly Euler, PT, DPT
• Angela Rochelle Evans, RBT
• Bradley B Evans Sr., PSYD
• John S Evans Jr., LCSW, LMFT
• Heather Michele Evenson, RBT

• Professional Counselor in Killeen, TX
• Providers in Killeen, 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 27, 2026; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.