Individual provider Active NPI

Marjorie Y Mendoza, LPC

  • Professional Counselor
  • West Allis, WI
National Provider Identifier
1124324090
Registry record updated Aug 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
7114-125 Issued in WI
Practice address
1205 S 70TH St Ste 301
West Allis, WI 53214-3171
Phone
(414) 485-6302
NPI assigned
Feb 9, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 7114-125 WI Primary
Addiction (Substance Use Disorder) Counselor 101YA0400X 15574-132 WI

Addresses

Primary practice location

1205 S 70TH St Ste 301
West Allis, WI 53214-3171

Mailing address

8321 S 100TH St
Franklin, WI 53132-2409
Phone (414) 719-0076

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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

Enrollment IDStateProvider typePAC IDDetails
I20240227000821 WI Practitioner - Mental Health Counselor 8123463437 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Professional Services Group Inc.Group PAC ID 8224296454, 22 clinicians

Practice addresses (Care Compare)

1205 S 70TH St
Suite 301
West Allis, WI 53214-3167
Phone (414) 475-2788

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
15574-132WIMDAddiction (Substance Use Disorder) Counselor
7114-125WIMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Professional Services Group, Inc. Addiction (Substance Use Disorder) CurrentSince Feb 13, 2024 Accepting new patients

Locations

2108 63rd St
Kenosha, WI 53143

6233 39th Ave
Kenosha, WI 53142
Phone (262) 654-1004

1205 S 70th St
Ste 301
West Allis, WI 53214
Phone (414) 475-2788

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1297209600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724803200000",
    "number": "1124324090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8321 S 100TH ST",
            "city": "FRANKLIN",
            "state": "WI",
            "postal_code": "531322409",
            "telephone_number": "414-719-0076"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1205 S 70TH ST STE 301",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "532143171",
            "telephone_number": "414-485-6302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENDOZA",
        "first_name": "MARJORIE",
        "middle_name": "Y",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-02-09",
        "last_updated": "2024-08-28",
        "certification_date": "2024-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "7114-125",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "15574-132",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Allis, WI

Sources for this page

Verify at the official NPI Registry.