Mark Richard Amundsen, DMIN
Individual provider Active NPI Professional Counselor · Glendale, WI
NPI 1053404665 · NPPES record last updated Jul 14, 2022
Key facts
- NPI
- 1053404665
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 4127-125 (WI)
- Practice address
- 5650 N Greenbay Ave
Glendale, WI 53209 - Phone
- (262) 789-1191
- NPI assigned
- Oct 2, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4127-125 | WI | MD | Professional Counselor |
| LH00009180 | WA | MD | Marriage & Family Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | LH00009180 | WA | |
| Professional Counselor | 101YP2500X | 4127-125 | WI | Yes |
Addresses
Primary practice location
5650 N Greenbay Ave
Glendale, WI 53209
Mailing address
5650 N Greenbay Ave
Glendale, WI 53209
Phone (262) 789-1191
Other providers in Glendale, WI
- Allergy Research & Care SC
- Carlynn Ann Alt
- Kurt Alt
- Kamal Amin
- Karalee R Amrozewicz
- Macy Ruth Anderson
- Angels on Call Homecare and Medical Staffing LLC
- Chinyere Jennifer Anyanwu
- Aragon Community Services LLC
- Ascension Medical Group-Southeast Wisconsin Inc
All providers in Glendale, WI · Professional Counselor in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 14, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.