MEDICARE: JONATHAN MORALES VALADEZ PCTL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	12154-125	WI
2	101YP2500X	Professional Counselor	12154-125	WI
3	101YP2500X	Professional Counselor	7339-226	WI

General Provider Information

NPI Number	:	1689366387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN MORALES VALADEZ PCTL

Provider Business Mailing Address
First Line	:	2363 S 102ND ST STE 303
Second Line	:
City	:	WEST ALLIS
State	:	WI
Zip	:	53227-2115
Country	:	US
Telephone Number	:	414-204-5174
Fax Number	:

Provider Business Practice Location Address
First Line	:	6025 N GREEN BAY AVE STE 2
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53209-3750
Country	:	US
Telephone Number	:	414-247-0801
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2023
Last Update Date	:	03/12/2026

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