Individual provider Active NPI

Kathy Koeppen, LMFT

  • Marriage & Family Therapist
  • McKinleyville, CA
National Provider Identifier
1245420009
Registry record updated Dec 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
48981 Issued in CA
Practice address
2620 Central Ave
McKinleyville, CA 95519-3619
Phone
(707) 362-6662
NPI assigned
Jul 27, 2007
Last updated
Dec 7, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 48981 CA Primary

Addresses

Primary practice location

2620 Central Ave
McKinleyville, CA 95519-3619

Mailing address

1966 Sycamore CT
McKinleyville, CA 95519-3901
Phone (707) 362-6662

Other practice location 1

3960 Walnut Dr
Eureka, CA 95503-8938
Phone (707) 268-8722

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
48981CAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Redwoods Rural Health Center Inc. CurrentSince Dec 10, 2023 Accepting new patients
Redwoods Rural Health Center Inc. PastSince Dec 10, 2023 Accepting new patients
Covenant Counseling Center Past Accepting new patients
Remi Vista Inc. Past Accepting new patients

Locations

2620 Central Ave
McKinleyville, CA 95519
Phone (707) 362-6662

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1185494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701907200000",
    "number": "1245420009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1966 SYCAMORE CT",
            "city": "MCKINLEYVILLE",
            "state": "CA",
            "postal_code": "955193901",
            "telephone_number": "707-362-6662",
            "fax_number": "707-268-0218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2620 CENTRAL AVE",
            "city": "MCKINLEYVILLE",
            "state": "CA",
            "postal_code": "955193619",
            "telephone_number": "707-362-6662"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3960 Walnut Dr",
            "address_purpose": "LOCATION",
            "city": "Eureka",
            "state": "CA",
            "postal_code": "955038938",
            "country_code": "US",
            "telephone_number": "707-268-8722",
            "fax_number": "707-268-0218",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOEPPEN",
        "first_name": "KATHY",
        "credential": "LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-27",
        "last_updated": "2023-12-07",
        "certification_date": "2023-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "48981",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in McKinleyville, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 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.