Jordan Lee Johnson, MA, LPC, LPCC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

CC00629 Issued in MN

Practice address

6303 Osgood Ave N
Stillwater, MN 55082-6101

Phone

(651) 383-4800

Fax

(651) 383-4801

NPI assigned

Dec 2, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Specialty

Mental Health Counselor

Education

Other, 2010

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

Interoperability endpoints

• Direct secure messaging: lifestancehealth.jordanjohnson@149809.advancedmd-direct.com

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

{
    "created_epoch": "1259712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1380758400000",
    "number": "1023346012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6303 OSGOOD AVE N",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "550826101",
            "telephone_number": "651-383-4800",
            "fax_number": "651-383-4801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6303 OSGOOD AVE N",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "550826101",
            "telephone_number": "651-383-4800",
            "fax_number": "651-383-4801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JORDAN",
        "middle_name": "LEE",
        "credential": "MA, LPC, LPCC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-12-02",
        "last_updated": "2013-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "4851-125",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "CC00629",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1023346012",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1023346012",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jjel,LLC
• John F. Reardon DDS, PA
• Carla Rae Johnson, CNP
• Daniel Theodore Johnson Jr., DDS
• Danielle Renee Johnson
• Julie Ann Johnson, RN
• Karen E Johnson, CNP
• McKenna Noelle Johnson, PT, DPT
• Nicole Marjorie Johnson
• Samuel Johnson

• Professional Counselor in Stillwater, MN
• Providers in Stillwater, MN by specialty
• Professional Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.