Tiffany Kettermann, LPC, CADCI

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

7415 N Oatman Ave
Portland, OR 97217-1213

Phone

(971) 270-0167

NPI assigned

Mar 25, 2013

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Tiffany Kettermann, LLC

  • Mental Health Counselor
  • Portland, OR
  • NPI 1003461740

  Addiction (Substance Use Disorder)

  Medicare reassignment NPD Authorized official
• Health Allies

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Portland, OR
  • NPI 1346895984
  NPD Authorized official

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

{
    "created_epoch": "1364169600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1444694400000",
    "number": "1194067355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7415 N OATMAN AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972171213",
            "telephone_number": "971-270-0167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7415 N OATMAN AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972171213",
            "telephone_number": "971-270-0167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KETTERMANN",
        "first_name": "TIFFANY",
        "credential": "LPC, CADCI",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-03-25",
        "last_updated": "2015-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mark Steven Kestner, MD
• Kristi Ketchum, MSW, LCSW
• Elias Zewdu Ketema
• Melissa Anne Ketrenos, L.M.T.
• Briana Nicole Ketterer Revoal, MD
• Ellana Rose Kettler
• Scarlett Paau Kettunen, LAC
• Kevin Driscoll DPM, LLC
• Sarah Key-Delyria, CCC-SLP
• Douglas J Key, MD

• Mental Health Counselor in Portland, OR
• Providers in Portland, OR by specialty
• Mental Health Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.