Mark Daniel Dittloff, MS, LPC
Individual provider Active NPI Professional Counselor · Oconto, WI
NPI 1194965590 · NPPES record last updated Nov 11, 2022
Key facts
- NPI
- 1194965590
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 8608-125 (WI)
- Practice address
- 820 Arbutus Ave
Oconto, WI 54153-2004 - Phone
- (920) 834-8833
- Fax
- (920) 834-8830
- NPI assigned
- Feb 24, 2009
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 17
Medicare Care Compare profile
- Specialty
- Mental Health Counselor
- Education
- Other, 1990
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Oconto Hospital and Medical Center Inc
Practice addresses (Care Compare)
820 Arbutus Ave
Oconto, WI 54153-2004
Phone (920) 835-1100
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WI, MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240101000030 | WI | Practitioner - Mental Health Counselor | 4183074370 | Reassigns benefits to 2 organizations |
| I20240702001307 | MI | Practitioner - Mental Health Counselor | 4183074370 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 64969 | TX | MD | Professional Counselor |
| 8608-125 | WI | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bellin Psychiatric Center Inc. | Current | Accepting new patients | |
| Oconto Hospital & Medical Center, Inc. | Current | Accepting new patients | |
| Oconto Hospital & Medical Center Inc | Current |
Accepting new patients | |
| Bellin Psychiatric Center Inc. | Current |
Accepting new patients | |
| Oconto Hospital & Medical Center, Inc. | Current |
Accepting new patients | |
| Bellin Psychiatric Center Inc | Current | Accepting new patients | |
| Bellin Psychiatric Center Inc | Current |
Accepting new patients | |
| Oconto Hospital & Medical Center Inc | Current |
Accepting new patients | |
| CCD Counseling PA | Past | Accepting new patients |
Locations
106 S School Rd
Daggett, MI 49821
Phone (906) 753-2155
440 Woodward Ave
Iron Mountain, MI 49801
Phone (906) 776-9040
1100 10th St
Menominee, MI 49858
Phone (906) 863-2256
301 Saint Joseph St
Green Bay, WI 54301
Phone (920) 430-3630
744 S Webster Ave
Green Bay, WI 54301
Phone (920) 433-6025
820 Arbutus Ave
Oconto, WI 54153
Phone (920) 835-1100
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 64969 | TX | |
| Professional Counselor | 101YP2500X | 8608-125 | WI | Yes |
Addresses
Primary practice location
820 Arbutus Ave
Oconto, WI 54153-2004
Mailing address
PO Box 1866
Green Bay, WI 54305-1866
Phone (920) 445-7210
Other practice location 1
1512 Scripture St
Denton, TX 76201-3916
Phone (940) 382-5328 ext. 19
Other practice location 2
301 E Saint Joseph St
Green Bay, WI 54301-2241
Phone (920) 433-3630
Other providers in Oconto, WI
- Community Memorial Hospital, Incorporated
- Brook Ann Coopman
- Norma Picio Cruz
- Katie Daniels
- Jean Sophie Delforge
- Lori Jo Eklund Walsh
- Michele Exworthy
- Kirstin L Filkey
- Kelly A Foust
- Gondeck Services LLC
All providers in Oconto, 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 Nov 11, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.