Individual provider Active NPI

Moriah Chere Gomez White, LPC

  • Professional Counselor
  • Racine, WI
National Provider Identifier
1154016046
Registry record updated Aug 12, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
11872 Issued in WI
Practice address
2333 Northwestern Ave
Racine, WI 53404-2520
Phone
(262) 652-2406
NPI assigned
Apr 7, 2023
Last updated
Aug 12, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X 7317 WI
Professional Counselor 101YP2500X 11872 WI Primary

Addresses

Primary practice location

2333 Northwestern Ave
Racine, WI 53404-2520

Mailing address

6233 39TH Ave
Kenosha, WI 53142-7015
Phone (262) 654-1004

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
I20250703000326 WI Practitioner - Mental Health Counselor 9638682453 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
7317WIMDCounselor

Practice roles

OrganizationSpecialtyStatusNew patients
Professional Services Group, Inc. CurrentSince Jun 25, 2025 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1680825600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786492800000",
    "number": "1154016046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6233 39TH AVE",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531427015",
            "telephone_number": "262-654-1004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2333 NORTHWESTERN AVE",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "534042520",
            "telephone_number": "262-652-2406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOMEZ WHITE",
        "first_name": "MORIAH",
        "middle_name": "CHERE",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-04-07",
        "last_updated": "2026-08-12",
        "certification_date": "2026-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "WI",
            "license": "7317",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "11872",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Racine, WI

Sources for this page

Verify at the official NPI Registry.