Kristen Nicole Ketterman, MA, AMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

134157 Issued in CA

Practice address

1369 G St
Arcata, CA 95521-5820

Phone

(707) 633-3939

NPI assigned

Jun 22, 2021

Last updated

Jun 28, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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

Marriage and Family Therapist

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Humboldt Counseling ConnectionGroup PAC ID 5193160950, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Humboldt Counseling Connection

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Eureka, CA
  • NPI 1710768411
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1624320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687910400000",
    "number": "1083283238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1369 G ST",
            "city": "ARCATA",
            "state": "CA",
            "postal_code": "955215820",
            "telephone_number": "707-633-3939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1369 G ST",
            "city": "ARCATA",
            "state": "CA",
            "postal_code": "955215820",
            "telephone_number": "707-633-3939"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1802 California St",
            "address_purpose": "LOCATION",
            "city": "Eureka",
            "state": "CA",
            "postal_code": "955012808",
            "country_code": "US",
            "telephone_number": "707-443-7358",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "123 F St Ste F",
            "address_purpose": "LOCATION",
            "city": "Eureka",
            "state": "CA",
            "postal_code": "955011048",
            "country_code": "US",
            "telephone_number": "707-633-3939",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KETTERMAN",
        "first_name": "KRISTEN",
        "middle_name": "NICOLE",
        "credential": "MA, AMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-22",
        "last_updated": "2023-06-28",
        "certification_date": "2023-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "134157",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelly Cole Licensed Clinical Social Worker Inc
• Jessica Marie Kelly, BCBA
• Louis Kennedy, M.D.
• Hugh Kent, MD
• Stacey Diane Kett, LAC
• Cynthia Rose Kiehn-Mola, MA & PPS CREDENTAIL
• Andrew C Kim, MD
• Hanna Kim
• Sang Won Kim
• Martin Kimble, PA

• Marriage & Family Therapist in Arcata, CA
• Providers in Arcata, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2023; 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.