Active NPI
Deborah Faye Ketcham, LCMHC
- Mental Health Counselor
- Colchester, VT
National Provider Identifier
1710079918
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 0680000576
- Practice address
- 133 Blakely Rd
Suite 213
Colchester, VT 05446-4007 - Phone
- (802) 864-3999
- NPI assigned
- Sep 28, 2006
- Last updated
- Jul 9, 2007
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 0680000576 | VT | Primary |
Addresses
Primary practice location
133 Blakely Rd
Suite 213
Colchester, VT 05446-4007
Mailing address
133 Blakely Rd
Suite 213
Colchester, VT 05446-4007
Phone (802) 864-3999
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1008536 | Medicaid | VT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in VT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240206002060 | VT | Practitioner - Mental Health Counselor | 4183067200 | Practice locations: Saint Albans, VT |
Care Compare profile
Medicare Care Compare- Specialty
- Mental Health Counselor
- Education
- Other, 1999
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
319 S Main St
Suite 3
Saint Albans, VT 05478-6343
Phone (802) 999-7399
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0680000576 | VT | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159401600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1710079918",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "133 BLAKELY RD",
"address_2": "SUITE 213",
"city": "COLCHESTER",
"state": "VT",
"postal_code": "054464007",
"telephone_number": "802-864-3999"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "133 BLAKELY RD",
"address_2": "SUITE 213",
"city": "COLCHESTER",
"state": "VT",
"postal_code": "054464007",
"telephone_number": "802-864-3999"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KETCHAM",
"first_name": "DEBORAH",
"middle_name": "FAYE",
"name_prefix": "Ms.",
"credential": "LCMHC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-09-28",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "VT",
"license": "0680000576",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1008536",
"state": "VT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Colchester, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.