Angela Dellise, LPC, CSAC, CS-IT

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

5385-125 Issued in WI

Practice address

6233 Durand Ave
Mount Pleasant, WI 53406-4961

Phone

(262) 554-8165

NPI assigned

Jun 28, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Specialty

Mental Health Counselor

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Professional Services Group Inc. 22 clinicians

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 and National Provider Directory roles.

• Professional Services Group, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Kenosha, WI
  • NPI 1619024262

  Addiction (Substance Use Disorder), WI

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1309219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1409011200000",
    "number": "1164718151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3900 W BROWN DEER RD",
            "address_2": "SUITE 200",
            "city": "BROWN DEER",
            "state": "WI",
            "postal_code": "532091220",
            "telephone_number": "414-540-2170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6233 DURAND AVE",
            "city": "MOUNT PLEASANT",
            "state": "WI",
            "postal_code": "534064961",
            "telephone_number": "262-554-8165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DELLISE",
        "first_name": "ANGELA",
        "credential": "LPC, CSAC, CS-IT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-28",
        "last_updated": "2014-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "5385-125",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "16057-130",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Michael Derose, LCSW

• All providers in Mount Pleasant, WI
• Professional Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2014; 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.