Kathy Sue Dutridge, LAC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LPC-16803 Issued in AZ

Practice address

1540 W Van Buren St
Phoenix, AZ 85007-2414

Phone

(602) 252-7330

Fax

(602) 252-4797

NPI assigned

Nov 10, 2014

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AZ

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

University of Arizona College of Medicine, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Maricopa County Special Health Care DistrictGroup PAC ID 4688583651, 124 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• Maricopa County Special Health Care District

  • General Acute Care Hospital
  • Phoenix, AZ
  • NPI 1073576740
  Medicare reassignment Care Compare group NPD
• Maricopa County Special Health Care District

  • Adult Mental Health Clinic/Center
  • Mesa, AZ
  • NPI 1003273855
  NPD
• Maricopa County Special Health Care District

  • Federally Qualified Health Center (FQHC)
  • Mesa, AZ
  • NPI 1306265145
  NPD
• Maricopa County Special Health Care District

  • Federally Qualified Health Center (FQHC)
  • Phoenix, AZ
  • NPI 1629497474
  NPD (past)

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

{
    "created_epoch": "1415577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704758400000",
    "number": "1902202567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 E EARLL DR",
            "address_2": "SUITE 200",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850122647",
            "telephone_number": "602-599-5404",
            "fax_number": "602-599-5704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1540 W VAN BUREN ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850072414",
            "telephone_number": "602-252-7330",
            "fax_number": "602-252-4797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUTRIDGE",
        "first_name": "KATHY",
        "middle_name": "SUE",
        "credential": "LAC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-11-10",
        "last_updated": "2024-01-09",
        "certification_date": "2024-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "AZ",
            "license": "LPC-16803",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LAC LICENSE",
            "identifier": "LAC-13064",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joyce Dusabe
• Wendy L Dusenbury, ARNP
• Matthew Duske, PA-C
• Dustin D. Karren D.M.D,P.C.
• Rebecca Dutcher, RPH
• Courtney Dutry, DPT
• Elliot Dutton
• Jentry Jania Dutton, SLPA
• Susan Marie Dutton, M.N.S. CCC-SLP
• Sorin Dutu, CAREGIVER

• Mental Health Counselor in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Mental Health Counselor in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 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.
• 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.