Judith Tart Kettner, LPC MS LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

NC LMFT 516 Issued in NC

Practice address

200 Valencia Dr
Suite 109
Jacksonville, NC 28546-7356

Phone

(910) 346-9000

Fax

(910) 355-0672

NPI assigned

Dec 1, 2005

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1133395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1338768000000",
    "number": "1982688180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 VALENCIA DR",
            "address_2": "SUITE 109",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285467356",
            "telephone_number": "910-346-9000",
            "fax_number": "910-355-0672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 VALENCIA DR",
            "address_2": "SUITE 109",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285467356",
            "telephone_number": "910-346-9000",
            "fax_number": "910-355-0672"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KETTNER",
        "first_name": "JUDITH",
        "middle_name": "TART",
        "credential": "LPC MS LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-12-01",
        "last_updated": "2012-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "NC LPC 3778",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NC",
            "license": "NC LMFT 516",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "131CH",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christian Carl Kerlick Jr., IDC
• Tavon Amber Kermeen, LCMHC
• Lydia Kerns, LCSW, LCAS-A
• Brittany Kersey
• Jenny Ketterer, LCSW
• Booker T Keyes Jr., M.D.
• Jocelyn G Keyes, MSW, LCSWA, LCASA
• Leslie Adam Keyser, PA-C
• Hamzah Mohsin Khan
• Zi Wei Khor

• Marriage & Family Therapist in Jacksonville, NC
• Providers in Jacksonville, NC by specialty
• Marriage & Family Therapist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.