Katelynn Coughlin, LMFT
Individual provider Active NPI Marriage & Family Therapist · Ripon, WI
NPI 1114394129 · NPPES record last updated Mar 17, 2018
Key facts
- NPI
- 1114394129
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Marriage & Family Therapist 106H00000X
- License
- 1134-124 (WI)
- Practice address
- 112 Watson St
Ripon, WI 54971-1327 - Phone
- (920) 896-0189
- Fax
- (920) 694-3021
- NPI assigned
- Aug 25, 2015
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1134-124 | WI | MD | Marriage & Family Therapist |
| 468-228 | WI | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shaffer Counseling & Consulting | Past |
Accepting new patients | |
| Growing Oak LLC | Past | Accepting new patients | |
| Samaritan Counseling Center of the Fox Valley, Inc. | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 468-228 | WI | |
| Marriage & Family Therapist | 106H00000X | 1134-124 | WI | Yes |
Addresses
Primary practice location
112 Watson St
Ripon, WI 54971-1327
Mailing address
112 Watson St
Ripon, WI 54971-1327
Phone (920) 896-0189
Other practice location 1
1478 Kenwood Dr
Suite 1
Menasha, WI 54952-1161
Phone (920) 886-9319
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114394129 | Medicaid | WI |
Other names
- Katelynn Kinas
Other providers in Ripon, WI
- Michael J. Combs
- Community Health Network Inc
- Consultants Laboratory of Wisconsin, LLC
- Consultants Laboratory of Wisconsin, LLC
- Cooperleaf Management Group
- Danielle M Covach
- John Dalsbo
- Jessica L Davis
- Eric Demshar
- Glenn F. Devries
All providers in Ripon, WI · Marriage & Family Therapist in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 17, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.