Individual provider Active NPI

Mary Kathryn Pelman, MS, LPC

  • Professional Counselor
  • Mequon, WI
National Provider Identifier
1407029952
Registry record updated Sep 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
4143-125 Issued in WI
Practice address
11518 N Port Washington Rd Ste 202
Mequon, WI 53092-3443
Phone
(262) 244-6177
Fax
(262) 299-3040
NPI assigned
Apr 4, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 4143-125 WI Primary

Addresses

Primary practice location

11518 N Port Washington Rd Ste 202
Mequon, WI 53092-3443

Mailing address

1035 W Glen Oaks LN Ste 110
Mequon, WI 53092-3392

Other identifiers 1

IdentifierTypeStateIssuer
40943200MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
4143-125WIMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Cornerstone Counseling Services, Inc CurrentSince Mar 1, 2023 Accepting new patients

Locations

11518 N Port Washington Rd
Ste 202
Mequon, WI 53092
Phone (262) 244-6177

1035 W Glen Oaks Ln
Ste 110
Mequon, WI 53092
Phone (262) 240-0299

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1207267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600041600000",
    "number": "1407029952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1035 W GLEN OAKS LN STE 110",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530923392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11518 N PORT WASHINGTON RD STE 202",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530923443",
            "telephone_number": "262-244-6177",
            "fax_number": "262-299-3040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PELMAN",
        "first_name": "MARY",
        "middle_name": "KATHRYN",
        "credential": "MS, LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-04",
        "last_updated": "2020-09-14",
        "certification_date": "2020-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "4143-125",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40943200",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mequon, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2020; 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.