Marvin A Valdez, SAC-IT

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

18063130 Issued in WI

Practice address

1610 Miller Park Way
West Milwaukee, WI 53214-3604

Phone

(414) 672-3801

Fax

(414) 672-6026

NPI assigned

May 23, 2019

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Rising Tides Counseling, LLC

  • Professional Counselor
  • Pleasant Prairie, WI
  • NPI 1699500611
  NPD Authorized official
• Faith Factory LLC

  • Professional Counselor
  • Milwaukee, WI
  • NPI 1265151906
  NPD (past)

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

{
    "created_epoch": "1558569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1558569600000",
    "number": "1801453048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1610 MILLER PARK WAY",
            "city": "WEST MILWAUKEE",
            "state": "WI",
            "postal_code": "532143604",
            "telephone_number": "414-672-3801",
            "fax_number": "414-672-6026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1610 MILLER PARK WAY",
            "city": "WEST MILWAUKEE",
            "state": "WI",
            "postal_code": "532143604",
            "telephone_number": "414-672-3801",
            "fax_number": "414-672-6026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VALDEZ",
        "first_name": "MARVIN",
        "middle_name": "A",
        "credential": "SAC-IT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-05-23",
        "last_updated": "2019-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "18063130",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SAC-IT",
            "identifier": "18063130",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dawn Marie Suchorski, SAC-IT
• Sunrise Supply LLC
• Tyler James Syltie, LAT/ATC
• Joshua Trevino
• Jacqueline Frances Truog I, LPN
• Wal-Mart Stores East LP
• Wal-Mart Stores East LP
• Mike Walker, EMT
• Laureal Ward, PHARMD
• Kristin Weber

• Addiction (Substance Use Disorder) Counselor in West Milwaukee, WI
• Providers in West Milwaukee, WI by specialty
• Addiction (Substance Use Disorder) Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2019; 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.