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General NPI Number Information
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NPI Number | 1689366387
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Entity Type | Individual
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Provider Name | JONATHAN MORALES VALADEZ PCTL
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Gender | Male
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Dates
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Enumeration Date | 05/22/2023
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 6025 N GREEN BAY AVE STE 2
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City | MILWAUKEE
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State | WI
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Zip | 53209-3750
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Country | US
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Telephone | 414-247-0801
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Fax |
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Provider Business Mailing Address
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Address Line | 2363 S 102ND ST STE 303
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City | WEST ALLIS
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State | WI
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Zip | 53227-2115
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Country | US
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Telephone | 414-204-5174
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 7339-226
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 12154-125
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License Number State | WI
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