Active NPI
Kathleen Phillips
- Counselor
- Potter Valley, CA
National Provider Identifier
1124510342
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- Practice address
- 9981 Spring Valley Rd Unit B
Potter Valley, CA 95469-9713 - Phone
- (707) 743-1015
- NPI assigned
- Jun 4, 2018
- Last updated
- Jul 31, 2019
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | |||
| Counselor | 101Y00000X | Primary |
Addresses
Primary practice location
9981 Spring Valley Rd Unit B
Potter Valley, CA 95469-9713
Mailing address
PO Box 2077
Ukiah, CA 95482-2077
Phone (707) 467-2010
Other practice location 1
110 E Mendocino Ave
Willits, CA 95490-3508
Phone (707) 459-6222
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Redwood Community Services, Inc | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Mental Illness Community Based Residential Treatment Facility
- Willits, CA
- NPI 1407351653
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1528070400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1564531200000",
"number": "1124510342",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2077",
"city": "UKIAH",
"state": "CA",
"postal_code": "954822077",
"telephone_number": "707-467-2010"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9981 SPRING VALLEY RD UNIT B",
"city": "POTTER VALLEY",
"state": "CA",
"postal_code": "954699713",
"telephone_number": "707-743-1015"
}
],
"practiceLocations": [
{
"address_1": "110 E Mendocino Ave",
"address_purpose": "LOCATION",
"city": "Willits",
"state": "CA",
"postal_code": "954903508",
"country_code": "US",
"telephone_number": "707-459-6222",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PHILLIPS",
"first_name": "KATHLEEN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-06-04",
"last_updated": "2019-07-31",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": false
},
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Potter Valley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.