Edmore Mangena, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

PCOP916 Issued in AK

Practice address

911 Meals Avenue
Valdez, AK 99686

Phone

(078) 352-8389

Fax

(907) 834-1890

NPI assigned

Apr 10, 2007

Last updated

Dec 21, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Enrolled in AK

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

City of ValdezGroup PAC ID 9931261005, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• City of Valdez

  dba Providence Valdez Counseling Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Valdez, AK
  • NPI 1962525097
  Medicare reassignment Care Compare group NPD
• Providence Health & Services Washington

  dba Providence Kodiak Island Counseling Center

  • Community/Behavioral Health Agency
  • Kodiak, AK
  • NPI 1477563344
  Medicare reassignment NPD

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

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640044800000",
    "number": "1629291422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 550",
            "city": "VALDEZ",
            "state": "AK",
            "postal_code": "996860550",
            "telephone_number": "907-835-2249",
            "fax_number": "907-834-1890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "911 MEALS AVENUE",
            "city": "VALDEZ",
            "state": "AK",
            "postal_code": "99686",
            "telephone_number": "078-352-8389",
            "fax_number": "907-834-1890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANGENA",
        "first_name": "EDMORE",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-10",
        "last_updated": "2021-12-21",
        "certification_date": "2021-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "AK",
            "license": "PCOP916",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Molly Leser, IDHS
• Debra Lynne Liljedahl
• Loving Kindness a Helping Hand, LLC
• Shannon M Mahoney, OTRL
• Shannon Major, LMSW
• Jeremy Edward Martin
• David L McCubbins, HS
• Elainy Dale McFaddin
• Amanda Jayne McNeely, PHARMD
• Benjamin Melton

• Professional Counselor in Valdez, AK
• Providers in Valdez, AK by specialty
• Professional Counselor in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2021; 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.