Nicole Johnson, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-19-36053 Issued in CO

Practice address

200 N Vineyard Blvd Ste A330
Honolulu, HI 96817-3950

Phone

(808) 425-0195

Fax

(808) 369-7106

NPI assigned

Mar 20, 2018

Reactivated

Dec 30, 2022

Last updated

Dec 12, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Sandal Gap Counseling Services LLC

  • Mental Health Counselor
  • Greeley, CO
  • NPI 1710740980
  NPD Authorized official
• Sandal Gap Comprehensive Services

  • Behavior Analyst
  • Kailua, HI
  • NPI 1356066344
  NPD (past) Authorized official

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

{
    "created_epoch": "1521504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733961600000",
    "number": "1134623663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 N VINEYARD BLVD STE A330",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968173950",
            "telephone_number": "808-425-0195",
            "fax_number": "808-369-7106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 N VINEYARD BLVD STE A330",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968173950",
            "telephone_number": "808-425-0195",
            "fax_number": "808-369-7106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "NICOLE",
        "credential": "BCBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-20",
        "last_updated": "2024-12-12",
        "certification_date": "2024-12-12",
        "deactivation_date": "2022-12-07",
        "reactivation_date": "2022-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "CO",
            "license": "1-19-36053",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leslie Martin Johnson Jr., PSYD
• Lynne White Johnson, RN,APRN
• Mariko Katherine Johnson, M.D.
• Marit Elise Johnson, P. T.
• Mary Porterfield Johnson, RN
• Rachel Claire Johnson
• Ryland Johnson, DPT
• Samantha Johnson
• Sarah K Johnson, LAC
• Shyretha Johnson, APRN, BC PMHNP

• Behavior Analyst in Honolulu, HI
• Providers in Honolulu, HI by specialty
• Behavior Analyst in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2024; 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.