Active NPI
Michael Kevin Johnson, PH.D.
- Clinical Psychologist
- Rockwall, TX
National Provider Identifier
1114298122
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 36113
- Practice address
- 2237 Ridge Rd
Ste 101
Rockwall, TX 75087-5164 - Phone
- (972) 771-3969
- Fax
- (972) 771-8258
- NPI assigned
- Jan 23, 2012
- Last updated
- Dec 13, 2016
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 36113 | TX | Primary |
Addresses
Primary practice location
2237 Ridge Rd
Ste 101
Rockwall, TX 75087-5164
Mailing address
2237 Ridge Rd
Ste 101
Rockwall, TX 75087-5164
Phone (972) 771-3969
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36113 | TX | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1327276800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1481587200000",
"number": "1114298122",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2237 RIDGE RD",
"address_2": "STE 101",
"city": "ROCKWALL",
"state": "TX",
"postal_code": "750875164",
"telephone_number": "972-771-3969",
"fax_number": "972-771-8258"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2237 RIDGE RD",
"address_2": "STE 101",
"city": "ROCKWALL",
"state": "TX",
"postal_code": "750875164",
"telephone_number": "972-771-3969",
"fax_number": "972-771-8258"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "MICHAEL",
"middle_name": "KEVIN",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-01-23",
"last_updated": "2016-12-13",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "TX",
"license": "36113",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rockwall, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2016; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.