Tina Johnson, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW-17813 Issued in AZ

Practice address

799 Cove Pkwy
Cottonwood, AZ 86326-4683

Phone

(701) 261-9685

NPI assigned

Apr 25, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AZ

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

Specialty

Clinical Social Worker

Education

Other, 1985

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Group practices

Tribe Wellness Group PLLCGroup PAC ID 0244589174, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Tribe Wellness Group PLLC

  • Neurology Physician
  • Cottonwood, AZ
  • NPI 1073004339
  Medicare reassignment Care Compare group NPD
• Oak Creek Psychiatric Mental Health NP PLLC

  • Multi-Specialty Clinic/Center
  • Cottonwood, AZ
  • NPI 1891567293
  NPD
• Sanctuary Cove Healthcare, PLLC

  • Family Nurse Practitioner
  • Cottonwood, AZ
  • NPI 1730799362
  NPD
• Center for Psychiatric Care

  • Psychiatry Physician
  • Grand Forks, ND
  • NPI 1043271885

  Clinical

  NPD (past)

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

{
    "created_epoch": "1145923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589155200000",
    "number": "1073579306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "270 S DESPERADO DR",
            "city": "COTTONWOOD",
            "state": "AZ",
            "postal_code": "863267356",
            "telephone_number": "701-261-9685",
            "fax_number": "701-346-1100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "799 COVE PKWY",
            "city": "COTTONWOOD",
            "state": "AZ",
            "postal_code": "863264683",
            "telephone_number": "701-261-9685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "TINA",
        "name_prefix": "Ms.",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-04-25",
        "last_updated": "2020-05-11",
        "certification_date": "2020-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AZ",
            "license": "LCSW-17813",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1454874",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robert H Jochim, MD
• Joe D. Ditterline, D.M.D., P.C.
• John C. French, M.D., P.C.
• John Schor MD PLC
• Riley Benjamin Johnson, RD
• Samantha Johnston, PA-C
• Shaeleen Johnston
• Joyce L. Richards, D.O. P.C.
• Juneau D Stump Jr MD PC
• Juniper Campbell PLLC

• Clinical Social Worker in Cottonwood, AZ
• Providers in Cottonwood, AZ by specialty
• Clinical Social Worker in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2020; 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.