Active NPI
Matthew Dean Johnson, LPCC-S
- Professional Counselor
- Rogers, AR
National Provider Identifier
1114062312
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- E.1000019-SUPV
- Practice address
- 1807 Prestwick PL
Rogers, AR 72758-1389 - Phone
- (479) 685-6595
- NPI assigned
- Feb 21, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | E.1000019-SUPV | OH | Primary |
Addresses
Primary practice location
1807 Prestwick PL
Rogers, AR 72758-1389
Mailing address
4581 S Hills Dr
Cleveland, OH 44109-4469
Phone (479) 685-6595
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
| License | State | Type | Specialty |
|---|---|---|---|
| E.1000019-SUPV | OH | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172016000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1369008000000",
"number": "1114062312",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4581 S HILLS DR",
"city": "CLEVELAND",
"state": "OH",
"postal_code": "441094469",
"telephone_number": "479-685-6595"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1807 PRESTWICK PL",
"city": "ROGERS",
"state": "AR",
"postal_code": "727581389",
"telephone_number": "479-685-6595"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "MATTHEW",
"middle_name": "DEAN",
"name_prefix": "Mr.",
"credential": "LPCC-S",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-21",
"last_updated": "2013-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "OH",
"license": "E.1000019-SUPV",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rogers, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.