MR. ROBERT CARL KETCHUM CATC1 NPI 1487025136

NPI Information

NPI: 1487025136
Provider Name: MR. ROBERT CARL KETCHUM, CATC1
Classification: Counselor - 101YA0400X
Entity Type: Individual

Specialization: Addiction (Substance Use Disorder)

Address:
1370 S STATE ST STE A
SAN JACINTO, CA
ZIP 92583
Phone: (951) 791-3350
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MR. Robert Carl Ketchum, CATC1 is an addiction (substance use disorder) counselor in San Jacinto, CA. MR. Robert Carl Ketchum, CATC1 NPI is 1487025136. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1370 S STATE ST STE A
SAN JACINTO, CA
ZIP 92583-922
Phone: (951) 791-3350
Fax: (951) 791-3353

The enumeration date for this NPI number is 10/7/2015 and was last updated on 4/16/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YA0400X	Counselor	Addiction (Substance Use Disorder)	K1208311033	CALIFORNIA	No
2	171M00000X	Case Manager/Care Coordinator		C054940518	CALIFORNIA	No
3	101YA0400X	Counselor	Addiction (Substance Use Disorder)	C054940518	CALIFORNIA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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