Individual provider Active NPI

Courtney S. Johnson, LPC

  • Professional Counselor
  • Meridian, ID
National Provider Identifier
1013586395
Registry record updated Oct 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
LPC-8187 Issued in ID
Practice address
1047 S Wells St
Meridian, ID 83642-7997
Phone
(208) 670-5551
NPI assigned
Jun 22, 2021
Last updated
Oct 27, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X LPC-8187 ID Primary

Addresses

Primary practice location

1047 S Wells St
Meridian, ID 83642-7997

Mailing address

702 Sunset Dr
Ontario, OR 97914-3121
Phone (541) 889-9167

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
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

Enrollment IDStateProvider typePAC IDDetails
I20250424000551 ID Practitioner - Mental Health Counselor 0143746008 Practice locations: Meridian, ID

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LPC-8187IDMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Anchor Counseling Professional CurrentSince Aug 25, 2024 Accepting new patients

Locations

1047 S Wells St
Meridian, ID 83642
Phone (208) 398-3351

1047 S Wells St
Ste 105
Meridian, ID 83642
Phone (208) 670-5551

1047 S Wells St
Ste 5
Meridian, ID 83642

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1624320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729987200000",
    "number": "1013586395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 SUNSET DR",
            "city": "ONTARIO",
            "state": "OR",
            "postal_code": "979143121",
            "telephone_number": "541-889-9167",
            "fax_number": "541-889-7873"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1047 S WELLS ST",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836427997",
            "telephone_number": "208-670-5551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "COURTNEY",
        "middle_name": "S.",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-22",
        "last_updated": "2024-10-27",
        "certification_date": "2024-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "ID",
            "license": "LPC-8187",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Meridian, ID

Sources for this page

Verify at the official NPI Registry.