Kintsugi Behavioral Health LLC

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

Legal business name

KINTSUGI BEHAVIORAL HEALTH LLC

Doing business as

Kintsugi Behavioral Health

Practice address

3301 Salterbeck St Ste 101
Mt Pleasant, SC 29466-7165

Phone

(843) 410-9940

NPI assigned

Dec 16, 2024

Last updated

Dec 18, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Katherine Mai, LISW-CPNPI 1902613607

Title

Psychotherapist

Phone

(843) 410-9940

Specialties & licenses 4

Addresses

Other names 1

• Kintsugi Behavioral Health Doing business as

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Katherine Mai, LISW-CP

  • Clinical Social Worker
  • Mount Pleasant, SC
  • NPI 1902613607
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1734307200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734480000000",
    "number": "1457168163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3301 SALTERBECK ST STE 101",
            "city": "MT PLEASANT",
            "state": "SC",
            "postal_code": "294667165",
            "telephone_number": "843-410-9940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3301 SALTERBECK ST STE 101",
            "city": "MT PLEASANT",
            "state": "SC",
            "postal_code": "294667165",
            "telephone_number": "843-410-9940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KINTSUGI BEHAVIORAL HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-16",
        "last_updated": "2024-12-18",
        "certification_date": "2024-12-18",
        "status": "A",
        "authorized_official_last_name": "MAI",
        "authorized_official_first_name": "KATHERINE",
        "authorized_official_title_or_position": "PSYCHOTHERAPIST",
        "authorized_official_telephone_number": "843-410-9940",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LISW-CP"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kintsugi Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kintsugi Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Callie Elizabeth Kimm, DPT
• Amy C King, CNS
• Jill King
• Joshua James King, PA-S
• Kimberly Underwood King
• Leslie Elizabeth Kirk, O.D.
• Ashton Medlin Kirkpatrick, DPT
• Foster Sue Kirkpatrick
• Catherine Emily Kister, O.D.
• Robyn Michele Kitchell

• Adult Mental Health Clinic/Center in Mount Pleasant, SC
• Providers in Mount Pleasant, SC by specialty
• Adult Mental Health Clinic/Center in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.