Tara Lynn Ketteringham, LCPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LC12334 Issued in MD

Practice address

5412 Old National Pike
Frederick, MD 21702-3640

Phone

(240) 490-0256

NPI assigned

Apr 9, 2019

Last updated

Feb 21, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1554768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676937600000",
    "number": "1104389071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5412 OLD NATIONAL PIKE",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217023640",
            "telephone_number": "240-490-0256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5412 OLD NATIONAL PIKE",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217023640",
            "telephone_number": "240-490-0256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KETTERINGHAM",
        "first_name": "TARA",
        "middle_name": "LYNN",
        "credential": "LCPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-04-09",
        "last_updated": "2023-02-21",
        "certification_date": "2023-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MD",
            "license": "LC12334",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MD",
            "license": "LGP9228",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Frederick, MD
• Providers in Frederick, MD by specialty
• Professional Counselor in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.