Active NPI
Elise Marie Mederos, M.A., LPC
- Professional Counselor
- Fort Worth, TX
National Provider Identifier
1447439807
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 60605
- Practice address
- 3815 Lisbon St
Suite 202
Fort Worth, TX 76107-5601 - Phone
- (817) 841-9110
- NPI assigned
- Nov 1, 2007
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 60605 | TX | Primary |
Addresses
Primary practice location
3815 Lisbon St
Suite 202
Fort Worth, TX 76107-5601
Mailing address
2016 Thomas PL
Fort Worth, TX 76107-3941
Phone (817) 851-2594
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 Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 60605 | TX | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1193875200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1462406400000",
"number": "1447439807",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2016 THOMAS PL",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761073941",
"telephone_number": "817-851-2594"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3815 LISBON ST",
"address_2": "SUITE 202",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761075601",
"telephone_number": "817-841-9110"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDEROS",
"first_name": "ELISE",
"middle_name": "MARIE",
"name_prefix": "Mrs.",
"credential": "M.A., LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-11-01",
"last_updated": "2016-05-05",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "60605",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.