Tracie Johnson, LLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Legal business name

TRACIE JOHNSON, LLC

Practice address

211 N Main St Ste 203
Spearfish, SD 57783-2646

Phone

(605) 641-7534

Fax

(605) 559-0512

NPI assigned

Jul 16, 2017

Organization subpart

No

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

Authorized official

Name

Tracie Bren-Clegg, LPC-MH

Title

Owner / Ceo

Phone

(605) 641-7534

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1500163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601337600000",
    "number": "1013439579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 N MAIN ST STE 203",
            "city": "SPEARFISH",
            "state": "SD",
            "postal_code": "577832646",
            "telephone_number": "605-641-7534",
            "fax_number": "605-559-0512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 N MAIN ST STE 203",
            "city": "SPEARFISH",
            "state": "SD",
            "postal_code": "577832646",
            "telephone_number": "605-641-7534",
            "fax_number": "605-559-0512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRACIE JOHNSON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-16",
        "last_updated": "2020-09-29",
        "certification_date": "2020-09-29",
        "status": "A",
        "authorized_official_last_name": "BREN-CLEGG",
        "authorized_official_first_name": "TRACIE",
        "authorized_official_title_or_position": "OWNER / CEO",
        "authorized_official_telephone_number": "605-641-7534",
        "authorized_official_credential": "LPC-MH"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2020; 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.