Active NPI
Rebecca Gayle Ketter, M.A., ED. S.
- Psychologist
- Lucasville, OH
National Provider Identifier
1104225010
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- OHI375410
- Practice address
- 2114 Cockrells Run Rd
Lucasville, OH 45648-8833 - Phone
- (740) 285-6778
- Fax
- (740) 259-2337
- NPI assigned
- Aug 15, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | OHI375410 | OH | Primary |
Addresses
Primary practice location
2114 Cockrells Run Rd
Lucasville, OH 45648-8833
Mailing address
2114 Cockrells Run Rd
Lucasville, OH 45648-8833
Phone (740) 285-6778
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OHI375410 | OH | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1408060800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1408060800000",
"number": "1104225010",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2114 COCKRELLS RUN RD",
"city": "LUCASVILLE",
"state": "OH",
"postal_code": "456488833",
"telephone_number": "740-285-6778",
"fax_number": "740-259-2337"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2114 COCKRELLS RUN RD",
"city": "LUCASVILLE",
"state": "OH",
"postal_code": "456488833",
"telephone_number": "740-285-6778",
"fax_number": "740-259-2337"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KETTER",
"first_name": "REBECCA",
"middle_name": "GAYLE",
"credential": "M.A., ED. S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-08-15",
"last_updated": "2014-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "OH",
"license": "OHI375410",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lucasville, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.