Makena Lizabeth Detlor, LPC-IT

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

7240-226 Issued in WI

Practice address

320 W Grand Ave Ste 304a
Wisconsin Rapids, WI 54495-2781

Phone

(715) 424-6960

NPI assigned

Feb 6, 2023

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Makena Lizabeth Guse Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Central Wisconsin Counseling Associates, LLC

  • Clinical Social Worker
  • Wisconsin Rapids, WI
  • NPI 1316012396
  NPD

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

{
    "created_epoch": "1675641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675641600000",
    "number": "1336845817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "443 STRODMAN AVE",
            "city": "WISCONSIN RAPIDS",
            "state": "WI",
            "postal_code": "544945934",
            "telephone_number": "608-338-3335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 W GRAND AVE STE 304A",
            "city": "WISCONSIN RAPIDS",
            "state": "WI",
            "postal_code": "544952781",
            "telephone_number": "715-424-6960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETLOR",
        "first_name": "MAKENA",
        "middle_name": "LIZABETH",
        "credential": "LPC-IT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-02-06",
        "last_updated": "2023-02-06",
        "certification_date": "2023-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WI",
            "license": "7240-226",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MAKENA",
            "last_name": "GUSE",
            "middle_name": "LIZABETH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Delis Counseling Group, LLC
• Candace R Delis, LPC, LPCC, LMHC
• Carl Deluca, DPT
• Erin Nichole Derrie, BCBA
• Sarah Derringer
• Tina Diaz
• Scott E Dickman, MD
• Dietrich Chiropractic, SC
• John B. Dietrich II, DC
• Marissa Nicole Dobratz, RN

• Mental Health Counselor in Wisconsin Rapids, WI
• Providers in Wisconsin Rapids, WI by specialty
• Mental Health Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2023; 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.