Katie Hersom, MA

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LPC.0020286 Issued in CO

Practice address

6863 Johnson St
Arvada, CO 80004-2948

Phone

(720) 443-3934

NPI assigned

Feb 19, 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 CO

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

Specialty

Mental Health Counselor

Education

Other, 2020

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Group practices

Samantha Ivy LLCGroup PAC ID 0840552386, 12 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

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.

• Samantha Ivy LLC

  • Clinical Social Worker
  • Arvada, CO
  • NPI 1427557008
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1708300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710288000000",
    "number": "1043075161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6062 ESTES ST",
            "city": "ARVADA",
            "state": "CO",
            "postal_code": "800045444",
            "telephone_number": "720-443-3934"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6863 JOHNSON ST",
            "city": "ARVADA",
            "state": "CO",
            "postal_code": "800042948",
            "telephone_number": "720-443-3934"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERSOM",
        "first_name": "KATIE",
        "credential": "MA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-02-19",
        "last_updated": "2024-03-13",
        "certification_date": "2024-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CO",
            "license": "LPC.0020286",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Martha Henze, MS, RD
• Destiney Lynn Hernandez, RDH
• Paloma Hernandez
• Sonia Araceli Hernandez, DPT
• Gina N. Herrmann, M.D.
• Hestera Chiropractic
• Aimee Hestera, LPCC
• Dan Hestera, DC
• Benjamin Hettler, LCSW
• Higher Healing and Wellness LLC

• Mental Health Counselor in Arvada, CO
• Providers in Arvada, CO by specialty
• Mental Health Counselor in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.