Lisa Emily Theofelis, MC.61250418

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MC.61250418 Issued in WA

Practice address

1322 S 235TH PL
Des Moines, WA 98198-5426

Phone

(206) 914-4697

NPI assigned

Jan 20, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1642636800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642636800000",
    "number": "1851043863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1322 S 235TH PL",
            "city": "DES MOINES",
            "state": "WA",
            "postal_code": "981985426",
            "telephone_number": "206-914-4697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1322 S 235TH PL",
            "city": "DES MOINES",
            "state": "WA",
            "postal_code": "981985426",
            "telephone_number": "206-914-4697"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEOFELIS",
        "first_name": "LISA",
        "middle_name": "EMILY",
        "credential": "MC.61250418",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-20",
        "last_updated": "2022-01-20",
        "certification_date": "2022-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "MC.61250418",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lisa.theofelis@protonmail.com",
            "affiliation": "N",
            "endpointDescription": "email address secure",
            "address_1": "1322 S 235th Pl",
            "city": "Des Moines",
            "state": "WA",
            "country_code": "US",
            "postal_code": "981985426",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Mental Health Counselor in Des Moines, WA
• Providers in Des Moines, WA by specialty
• Mental Health Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2022; 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.