Active NPI
Kathryn Tkac, SUDCC
- Addiction (Substance Use Disorder) Counselor
- Fresno, CA
National Provider Identifier
1710270525
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 6973
- Practice address
- 2772 South Martin Luther King Jr. Blvd.
Fresno, CA 93706 - Phone
- (559) 265-4800
- NPI assigned
- May 26, 2011
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 6973 | CA | Primary |
Addresses
Primary practice location
2772 South Martin Luther King Jr. Blvd.
Fresno, CA 93706
Mailing address
3545 E Ashlan Ave
Apt#152
Fresno, CA 93726-3538
Phone (559) 226-5612
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6973 | Other | CA | SUDCC |
Other names 1
- Ms. Katie Tkac
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 |
|---|---|---|---|
| 6973 | CA | MD | Speech-Language Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| West Care | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Substance Abuse Rehabilitation Facility
- Fresno, CA
- NPI 1568590347
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1306368000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1675296000000",
"number": "1710270525",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3545 E ASHLAN AVE",
"address_2": "APT#152",
"city": "FRESNO",
"state": "CA",
"postal_code": "937263538",
"telephone_number": "559-226-5612"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2772 SOUTH MARTIN LUTHER KING JR. BLVD.",
"city": "FRESNO",
"state": "CA",
"postal_code": "93706",
"telephone_number": "559-265-4800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TKAC",
"first_name": "KATHRYN",
"name_prefix": "Ms.",
"credential": "SUDCC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-05-26",
"last_updated": "2023-02-02",
"certification_date": "2023-02-02",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CA",
"license": "6973",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SUDCC",
"identifier": "6973",
"state": "CA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "KATIE",
"last_name": "TKAC",
"prefix": "MS.",
"credential": "SUDCC",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Fresno, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.