Mary Elizabeth Ketchum, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

2188 Issued in MS

Practice address

100 Starr Ave Ste K
Starkville, MS 39759-4032

Phone

(662) 425-1051

Fax

(662) 200-5960

NPI assigned

Jul 5, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MS

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

Specialty

Mental Health Counselor

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

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.

• Starkville Wellness Group

  • Mental Health Counselor
  • Starkville, MS
  • NPI 1437763240
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1530748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631232000000",
    "number": "1659867307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "142 STIDHAM RD",
            "city": "MATHISTON",
            "state": "MS",
            "postal_code": "39752",
            "telephone_number": "662-425-1051",
            "fax_number": "662-327-1970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 STARR AVE STE K",
            "city": "STARKVILLE",
            "state": "MS",
            "postal_code": "397594032",
            "telephone_number": "662-425-1051",
            "fax_number": "662-200-5960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KETCHUM",
        "first_name": "MARY",
        "middle_name": "ELIZABETH",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-07-05",
        "last_updated": "2021-09-10",
        "certification_date": "2021-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MS",
            "license": "2188",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "069799252",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jayanthi Kaliyaperumal
• Karing Hands Transit LLC
• Tonia Carroll Kasper, LCSW, RPT
• Kermit D Laird MD PA
• Victor C. Kessler, M.D.
• Jessie Keyes, COTA/L
• Norma M Kimbrough, MA
• Rebecca Kimbrough, NCC, LPC, BC-TMH
• Nakii Kincaid
• Karli King

• Professional Counselor in Starkville, MS
• Providers in Starkville, MS by specialty
• Professional Counselor in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.