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Individual
MR. ROBERT CARL KETCHUM
Active
Individual
MR. ROBERT CARL KETCHUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CATC1
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
C054940518
CA
101YA0400X
Addiction (Substance Use Disorder) Counselor
K1208311033
CA
171M00000X
Case Manager/Care Coordinator
C054940518
CA
Other
Enumeration date
10/07/2015
Last updated
04/16/2024
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