Active NPI
Katie Ralph, LPC
- Professional Counselor
- Kenosha, WI
National Provider Identifier
1730822693
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 11365
- Practice address
- 2108 63Rd St
Kenosha, WI 53143-4454 - Phone
- (262) 652-2406
- NPI assigned
- Apr 19, 2022
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 19804-130 | WI | |
| Professional Counselor | 101YP2500X | 11365 | WI | Primary |
| Counselor | 101Y00000X | 5295 | WI |
Addresses
Primary practice location
2108 63Rd St
Kenosha, WI 53143-4454
Mailing address
6233 39TH Ave
Kenosha, WI 53142-7015
Phone (262) 654-1004
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19804-130 | WI | MD | Addiction (Substance Use Disorder) Counselor |
| 11365 | WI | MD | Professional Counselor |
| 5295 | WI | MD | Occupational Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Professional Services Group, Inc. | Addiction (Substance Use Disorder) | Current | Accepting new patients |
Locations
2108 63rd St
Kenosha, WI 53143
6233 39th Ave
Kenosha, WI 53142
Phone (262) 654-1004
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.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Kenosha, WI
- NPI 1619024262
Addiction (Substance Use Disorder)
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1650326400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1729468800000",
"number": "1730822693",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6233 39TH AVE",
"city": "KENOSHA",
"state": "WI",
"postal_code": "531427015",
"telephone_number": "262-654-1004"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2108 63RD ST",
"city": "KENOSHA",
"state": "WI",
"postal_code": "531434454",
"telephone_number": "262-652-2406"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RALPH",
"first_name": "KATIE",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-04-19",
"last_updated": "2024-10-21",
"certification_date": "2024-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "WI",
"license": "19804-130",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "WI",
"license": "11365",
"primary": true
},
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "WI",
"license": "5295",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Kenosha, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2024; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.