Individual provider Active NPI

Monica D Klisz, LPC

  • Professional Counselor
  • Richmond, VA
National Provider Identifier
1720261761
Registry record updated Feb 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
0701004298 Issued in VA
Practice address
3111 Northside Ave
Suite 101
Richmond, VA 23228-5441
Phone
(804) 366-4330
Fax
(866) 274-9962
NPI assigned
Dec 13, 2007
Last updated
Feb 21, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2024

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 0701004298 VA Primary

Addresses

Primary practice location

3111 Northside Ave
Suite 101
Richmond, VA 23228-5441

Mailing address

3111 Northside Ave
Suite 101
Richmond, VA 23228-5441
Phone (804) 366-4330

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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

Enrollment IDStateProvider typePAC IDDetails
I20240217000015 VA Practitioner - Mental Health Counselor 9638513609 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Virginia Commonwealth University, School of Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

3111 Northside Ave
Suite 101
Henrico, VA 23228-5441
Phone (804) 366-4330

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
MDK LLC CurrentSince Dec 20, 2023 Accepting new patients
MDK LLC Current Accepting new patients

Locations

3111 Northside Ave
Ste 101
Richmond, VA 23228
Phone (804) 366-4330

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1197504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708473600000",
    "number": "1720261761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3111 NORTHSIDE AVE",
            "address_2": "SUITE 101",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232285441",
            "telephone_number": "804-366-4330",
            "fax_number": "866-274-9962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3111 NORTHSIDE AVE",
            "address_2": "SUITE 101",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232285441",
            "telephone_number": "804-366-4330",
            "fax_number": "866-274-9962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLISZ",
        "first_name": "MONICA",
        "middle_name": "D",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-12-13",
        "last_updated": "2024-02-21",
        "certification_date": "2024-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "VA",
            "license": "0701004298",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Richmond, VA

Sources for this page

Verify at the official NPI Registry.