Kathleen M Hendrickson, LPCC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

E.0008267-SUPV Issued in OH

Practice address

3095 Kettering Blvd
Moraine, OH 45439-1983

Phone

(937) 293-8300

NPI assigned

Jan 13, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

South Community Inc.Group PAC ID 7315971066, 20 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• South Community Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Moraine, OH
  • NPI 1427289818
  Medicare reassignment Care Compare group NPD
• South Community Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Moraine, OH
  • NPI 1639128176
  NPD
• Integrated Youth Services Inc

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Dayton, OH
  • NPI 1710907597
  NPD (past)
• Integrated Youth Services, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Beavercreek, OH
  • NPI 1518138031
  NPD (past)

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

{
    "created_epoch": "1231804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631836800000",
    "number": "1891932851",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3095 KETTERING BLVD",
            "city": "MORAINE",
            "state": "OH",
            "postal_code": "454391983",
            "telephone_number": "937-293-8300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3095 KETTERING BLVD",
            "city": "MORAINE",
            "state": "OH",
            "postal_code": "454391983",
            "telephone_number": "937-293-8300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDRICKSON",
        "first_name": "KATHLEEN",
        "middle_name": "M",
        "name_prefix": "Miss",
        "credential": "LPCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-01-13",
        "last_updated": "2021-09-17",
        "certification_date": "2021-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OH",
            "license": "E.0008267-SUPV",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amelia Anne Heffern
• Nechelle D Heflin
• Helping Hands Home Health and Alternative Pain Management
• Jazmine S Helton
• Paul Andrew Hemminger
• Jami Henningsen, BA, LCDCIII, QMHS
• Shana Rocha Herron
• Nytasia Hicks
• Renee N Hicks, CDCA
• High Quality Staffing, LLC

• Professional Counselor in Moraine, OH
• Providers in Moraine, OH by specialty
• Professional Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2021; 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.

Verify at the official NPI Registry.