Active NPI
Kathleen J Peroutka
- Professional Counselor
- Moraine, OH
National Provider Identifier
1578868410
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- E2063
- Practice address
- 3131 S Dixie Dr
Suite 534
Moraine, OH 45439-2256 - Phone
- (937) 239-0170
- NPI assigned
- Jan 25, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | E2063 | OH | Primary |
Addresses
Primary practice location
3131 S Dixie Dr
Suite 534
Moraine, OH 45439-2256
Mailing address
1845 Pershing Blvd
Dayton, OH 45420-2426
Phone (937) 239-0170
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E2063 | OH | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1295913600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1295913600000",
"number": "1578868410",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1845 PERSHING BLVD",
"city": "DAYTON",
"state": "OH",
"postal_code": "454202426",
"telephone_number": "937-239-0170"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3131 S DIXIE DR",
"address_2": "SUITE 534",
"city": "MORAINE",
"state": "OH",
"postal_code": "454392256",
"telephone_number": "937-239-0170"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEROUTKA",
"first_name": "KATHLEEN",
"middle_name": "J",
"name_prefix": "Ms.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-01-25",
"last_updated": "2011-01-25",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "OH",
"license": "E2063",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Moraine, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.