Individual provider Active NPI

Stephanie Johnson, LMHC

  • Mental Health Counselor
  • Anthony, NM
National Provider Identifier
1083289169
Registry record updated May 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
CMH0210351 Issued in NM
Practice address
785 Anthony Drive
Anthony, NM 88021-2671
Phone
(575) 882-5100
Fax
(575) 882-1151
NPI assigned
May 21, 2021
Last updated
May 21, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 21, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X CMH0210351 NM Primary

Addresses

Primary practice location

785 Anthony Drive
Anthony, NM 88021-2671

Mailing address

PO Box 2671
Anthony, NM 88021-2671
Phone (575) 882-5100

Other identifiers 1

IdentifierTypeStateIssuer
35650338MedicaidNM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
CMH0210351NMMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Amanecer Community Counseling Center CurrentSince May 25, 2021 Accepting new patients
4 Directions Integrative Mental Health, LLC Past Accepting new patients
Amanecer Community Counseling Center, LLC PastSince May 25, 2021 Accepting new patients

Locations

785 Anthony Dr
Anthony, NM 88021
Phone (575) 882-5100

Organizations & group practices 3

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": "1621555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621555200000",
    "number": "1083289169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2671",
            "city": "ANTHONY",
            "state": "NM",
            "postal_code": "880212671",
            "telephone_number": "575-882-5100",
            "fax_number": "575-882-1151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "785 ANTHONY DRIVE",
            "city": "ANTHONY",
            "state": "NM",
            "postal_code": "880212671",
            "telephone_number": "575-882-5100",
            "fax_number": "575-882-1151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "STEPHANIE",
        "credential": "LMHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-21",
        "last_updated": "2021-05-21",
        "certification_date": "2021-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NM",
            "license": "CMH0210351",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "35650338",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Anthony, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2021; 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.