Jose Mateo Gomez, MA, LPC, CAADC, CCS

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

6401018930 Issued in MI

Practice address

30521 Schoenherr Rd # 200a
Warren, MI 48088-3161

Phone

(586) 275-7308

Fax

(248) 609-7472

NPI assigned

Apr 19, 2012

Last updated

Dec 22, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

MCCD FL Psychiatry Services PAGroup PAC ID 4880064070, 751 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• MCCD FL Psychiatry Services PA

  dba Talkiatry

  • Psychiatry Physician
  • Jacksonville, FL
  • NPI 1659003457

  MI

  Medicare reassignment Care Compare group NPD
• Jose M Gomez Ma LPC Caadc CCS LLC

  • Professional Counselor
  • Warren, MI
  • NPI 1194483321
  NPD Authorized official
• Diversity Counseling LLC

  • Addiction (Substance Use Disorder) Counselor
  • Cranston, RI
  • NPI 1033868930
  NPD
• Bio-Med Behavioral Health Services

  • Addiction (Substance Use Disorder) Counselor
  • Roseville, MI
  • NPI 1417099417
  NPD (past)

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

{
    "created_epoch": "1334793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608595200000",
    "number": "1558628271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30521 SCHOENHERR RD # 200A",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480883161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30521 SCHOENHERR RD # 200A",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480883161",
            "telephone_number": "586-275-7308",
            "fax_number": "248-609-7472"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOMEZ",
        "first_name": "JOSE",
        "middle_name": "MATEO",
        "name_prefix": "Mr.",
        "credential": "MA, LPC, CAADC, CCS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-04-19",
        "last_updated": "2020-12-22",
        "certification_date": "2020-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "6401018930",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Golden Years Home Care LLC
• Golden Years Home Help LLC
• Gregg Golden, PT
• Charles Robert Goldstein, DDS
• Maribel Gomez Quesada
• Good N Plenty RX LLC (Godd N Plenty Rx LLC)
• Grant Connor Goodfellow, D.O.
• Charles Michael Goodman, D.D.S.
• Ronald Scott Goodman, D.D.S.
• Laurie E Gordon, DDS

• Professional Counselor in Warren, MI
• Providers in Warren, MI by specialty
• Professional Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.