Kelly Mills Johnson, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY30455 Issued in CA

Practice address

1423 Broadway Ste 136
Oakland, CA 94612-2054

Phone

(415) 294-0412

NPI assigned

Apr 10, 2019

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 names 1

• Dr. Kelly J Mills Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1554854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630368000000",
    "number": "1194288753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1423 BROADWAY STE 136",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946122054",
            "telephone_number": "415-294-0412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1423 BROADWAY STE 136",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946122054",
            "telephone_number": "415-294-0412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KELLY",
        "middle_name": "MILLS",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-04-10",
        "last_updated": "2021-08-31",
        "certification_date": "2021-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY30455",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "MILLS",
            "middle_name": "J",
            "prefix": "DR.",
            "credential": "PSY.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Joy L. Johnson, PHD /LCSW/BCD
• Juliet Elizabeth Johnson, M.D.
• Karen Denice Johnson
• Karen Lynette Johnson, MHC
• Kelly Johnson
• Kelsey Johnson
• Kermit Johnson
• Kim Purnel Johnson
• Kimberly Joy Johnson, MFTI
• Komoia Johnson

• Clinical Psychologist in Oakland, CA
• Providers in Oakland, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 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.