Active NPI
Kourtni Ann Carabotta
- Mental Health Counselor
- Chardon, OH
National Provider Identifier
1114460771
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- C.1600628-TRNE
- Practice address
- 12557 Ravenwood Dr
Chardon, OH 44024-9009 - Phone
- (440) 285-3568
- NPI assigned
- Nov 29, 2016
- Last updated
- Jul 26, 2017
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | C.1600628-TRNE | OH | Primary |
Addresses
Primary practice location
12557 Ravenwood Dr
Chardon, OH 44024-9009
Mailing address
1917 Coltman Rd
Cleveland, OH 44106
Phone (440) 669-4058
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C.1600628-TRNE | OH | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1480377600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1501027200000",
"number": "1114460771",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1917 COLTMAN RD",
"city": "CLEVELAND",
"state": "OH",
"postal_code": "44106",
"telephone_number": "440-669-4058"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12557 RAVENWOOD DR",
"city": "CHARDON",
"state": "OH",
"postal_code": "440249009",
"telephone_number": "440-285-3568"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARABOTTA",
"first_name": "KOURTNI",
"middle_name": "ANN",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-11-29",
"last_updated": "2017-07-26",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "OH",
"license": "C.1600628-TRNE",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chardon, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.