Active NPI
Susan L Kehoe-Jergens, LMFT
- Marriage & Family Therapist
- Lakeport, CA
National Provider Identifier
1770868069
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- MFC37217
- Practice address
- 160 S Main St
Lakeport, CA 95453-5017 - Phone
- (707) 467-2010
- NPI assigned
- Oct 18, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | 37217 | CA | |
| Marriage & Family Therapist | 106H00000X | MFC37217 | CA | Primary |
Addresses
Primary practice location
160 S Main St
Lakeport, CA 95453-5017
Mailing address
PO Box 2077
Ukiah, CA 95482-2077
Phone (707) 467-2010
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 |
|---|---|---|---|
| MFC37217 | CA | MD | Marriage & Family Therapist |
| 37217 | CA | MD | Case Manager/Care Coordinator |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1318896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1586217600000",
"number": "1770868069",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2077",
"city": "UKIAH",
"state": "CA",
"postal_code": "954822077",
"telephone_number": "707-467-2010"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "160 S MAIN ST",
"city": "LAKEPORT",
"state": "CA",
"postal_code": "954535017",
"telephone_number": "707-467-2010"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KEHOE-JERGENS",
"first_name": "SUSAN",
"middle_name": "L",
"credential": "LMFT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-10-18",
"last_updated": "2020-04-07",
"certification_date": "2020-04-07",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": "CA",
"license": "37217",
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "MFC37217",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lakeport, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.