Mark John Derbas, LPC

Primary specialty

CounselorTaxonomy code 101Y00000X

License

1347-226 Issued in WI

Practice address

8503 75TH St.
Suite a
Kenosha, WI 53142-7620

Phone

(262) 654-9370

Fax

(262) 654-9379

NPI assigned

Apr 25, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Aalto Enhancement Center, S.C.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Kenosha, WI
  • NPI 1629155973
  NPD (past)

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

{
    "created_epoch": "1335312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626652800000",
    "number": "1316205594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8503 75TH ST.",
            "address_2": "SUITE A",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531427620",
            "telephone_number": "262-654-9370",
            "fax_number": "262-654-9379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8503 75TH ST.",
            "address_2": "SUITE A",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531427620",
            "telephone_number": "262-654-9370",
            "fax_number": "262-654-9379"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4305 Old Green Bay Rd",
            "address_purpose": "LOCATION",
            "city": "MT Pleasant",
            "state": "WI",
            "postal_code": "534039425",
            "country_code": "US",
            "telephone_number": "224-702-0429",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DERBAS",
        "first_name": "MARK",
        "middle_name": "JOHN",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-04-25",
        "last_updated": "2021-07-19",
        "certification_date": "2021-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "WI",
            "license": "1347-226",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Delta Medical Transportation
• Barbara Maria Denor, OTR
• Dental 360 Kenosha
• Dental Care Providers of America
• Virginia L Denton, SLP
• Amanda Derose, MCEP, DPT
• Nisha Deshpande, PA
• Jami J Detjens, B.S.
• Megan Elizabeth Devictoria, L.P.N.
• Kulwant Singh Dhaliwal, MD

• Counselor in Kenosha, WI
• Providers in Kenosha, WI by specialty
• Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.