Active NPI
Karisa Kloscak, LAC
- Mental Health Counselor
- Tempe, AZ
National Provider Identifier
1275944829
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- LAC-14520
- Practice address
- 2120 S McClintock Dr
Suite 105
Tempe, AZ 85282-2692 - Phone
- (480) 804-0326
- Fax
- (480) 302-7884
- NPI assigned
- May 16, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | LAC-14520 | AZ | Primary |
Addresses
Primary practice location
2120 S McClintock Dr
Suite 105
Tempe, AZ 85282-2692
Mailing address
2120 S McClintock Dr
Suite 105
Tempe, AZ 85282-2692
Phone (480) 804-0326
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 10, 2024 through Jan 10, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LAC-14520 | AZ | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1400198400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1400198400000",
"number": "1275944829",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2120 S MCCLINTOCK DR",
"address_2": "SUITE 105",
"city": "TEMPE",
"state": "AZ",
"postal_code": "852822692",
"telephone_number": "480-804-0326",
"fax_number": "480-302-7884"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2120 S MCCLINTOCK DR",
"address_2": "SUITE 105",
"city": "TEMPE",
"state": "AZ",
"postal_code": "852822692",
"telephone_number": "480-804-0326",
"fax_number": "480-302-7884"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KLOSCAK",
"first_name": "KARISA",
"credential": "LAC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-05-16",
"last_updated": "2014-05-16",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "AZ",
"license": "LAC-14520",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tempe, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.