Individual provider Active NPI

Rannen Roberson

  • Professional Counselor
  • Florence, KY
National Provider Identifier
1356027171
Registry record updated Aug 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
300887 Issued in KY
Practice address
4885 Houston Rd Ste 200
Florence, KY 41042-4894
Phone
(859) 525-0185
NPI assigned
Jun 26, 2023
Last updated
Aug 28, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X C2204465 OH
Mental Health Counselor 101YM0800X 285198 KY
Professional Counselor 101YP2500X 300887 KY Primary

Addresses

Primary practice location

4885 Houston Rd Ste 200
Florence, KY 41042-4894

Mailing address

3301 Cresentview LN
Cincinnati, OH 45248-4214

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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

Enrollment IDStateProvider typePAC IDDetails
I20251013000561 KY Practitioner - Mental Health Counselor 5698262921 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2010
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

256 Main St
Suite B
Florence, KY 41042-2029

256 Main St B
Florence, KY 41042-2050

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
285198KYMDMental Health Counselor
C2204465OHMDMental Health Counselor
300887KYMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Prodigal Ministries, LLC Mental Health CurrentSince Sep 1, 2025 Accepting new patients
Prodigal Ministries, LLC Professional PastSince Jan 7, 2024 Accepting new patients

Locations

256 Main St
Florence, KY 41042
Phone (502) 222-2389

51 Cavalier Blvd
Ste 240
Florence, KY 41042

Organizations & group practices 2

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": "1687737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756339200000",
    "number": "1356027171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3301 CRESENTVIEW LN",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452484214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4885 HOUSTON RD STE 200",
            "city": "FLORENCE",
            "state": "KY",
            "postal_code": "410424894",
            "telephone_number": "859-525-0185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERSON",
        "first_name": "RANNEN",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-26",
        "last_updated": "2025-08-28",
        "certification_date": "2025-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OH",
            "license": "C2204465",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "KY",
            "license": "285198",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "KY",
            "license": "300887",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Florence, KY

Sources for this page

Verify at the official NPI Registry.