Tide Falls Professional Counseling, LLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

74076 Issued in TX

Legal business name

TIDE FALLS PROFESSIONAL COUNSELING, LLC

Practice address

4231 Ridgecrest Cir Ste B
Amarillo, TX 79109-5498

Phone

(806) 803-5013

Fax

(806) 553-1312

NPI assigned

Apr 5, 2018

Organization subpart

No

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

Authorized official

Name

Katrina D Klaehn, MA, LPCNPI 1982151346

Title

Owner

Phone

(806) 803-5013

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Katrina Klaehn, MA, LPC Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Katrina D'Ann Klaehn, MA, LPC, LSOTP

  • Professional Counselor
  • Amarillo, TX
  • NPI 1982151346
  Medicare reassignment NPD Authorized official
• Matthew M Davis, LPC

  • Professional Counselor
  • Amarillo, TX
  • NPI 1871841981
  NPD

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

{
    "created_epoch": "1522886400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603584000000",
    "number": "1851897995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4231 RIDGECREST CIR STE B",
            "city": "AMARILLO",
            "state": "TX",
            "postal_code": "791095498",
            "telephone_number": "806-803-5013",
            "fax_number": "806-553-1312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4231 RIDGECREST CIR STE B",
            "city": "AMARILLO",
            "state": "TX",
            "postal_code": "791095498",
            "telephone_number": "806-803-5013",
            "fax_number": "806-553-1312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDE FALLS PROFESSIONAL COUNSELING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-05",
        "last_updated": "2020-10-25",
        "certification_date": "2020-10-25",
        "status": "A",
        "authorized_official_last_name": "KLAEHN",
        "authorized_official_first_name": "KATRINA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "806-803-5013",
        "authorized_official_credential": "MA, LPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "74076",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3025488-03",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Katrina Klaehn, MA, LPC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Shauna M Thornhill, O.D.
• Tate Thrash, PT
• Sarah Marie Thrasher, LPC
• Margaret E Thurmond-Anderle, MD
• Tiamat Enterprises, Inc.
• Angela Tidwell
• Lisa C Tidwell, LCSW
• Stephen Tidwell, D.O.
• Alyssa Marie Tienda, MD
• Reva Tilley, LPC

• Professional Counselor in Amarillo, TX
• Providers in Amarillo, TX by specialty
• Professional Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.