Wanda Ivelisse Castro-Medina, MS

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

84707 Issued in TX

Practice address

115 Dyanez St
Mercedes, TX 78570-5045

Phone

(210) 947-4024

NPI assigned

Sep 28, 2024

Sex

Female

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 TX

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

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

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 and National Provider Directory roles.

• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  Professional, TX

  Medicare reassignment NPD

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

{
    "created_epoch": "1727481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727481600000",
    "number": "1871311969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 DYANEZ ST",
            "city": "MERCEDES",
            "state": "TX",
            "postal_code": "785705045",
            "telephone_number": "210-947-4024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 DYANEZ ST",
            "city": "MERCEDES",
            "state": "TX",
            "postal_code": "785705045",
            "telephone_number": "210-947-4024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CASTRO-MEDINA",
        "first_name": "WANDA",
        "middle_name": "IVELISSE",
        "credential": "MS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-09-28",
        "last_updated": "2024-09-28",
        "certification_date": "2024-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "84707",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Casa Veronica
• Alma Aracely Casanova, COTA
• Kevin Casas, PTA
• Eric Luciano Castillo, COTA
• Saul Carlos Castillo
• Yaneli Castro, LMT
• Cavalry EMS LLC
• Javier Eduardo Cavazos
• Ariel Jacklyn Champion, PHARM.D.
• Amber Renee Chavez, OTR/L

• Professional Counselor in Mercedes, TX
• Providers in Mercedes, TX by specialty
• Professional Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.