Kimberly Anne Johnson, LCPC
Individual provider Active NPI Mental Health Counselor · Coeur D Alene, ID
NPI 1194940486 · NPPES record last updated Mar 4, 2025
Key facts
- NPI
- 1194940486
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- Practice address
- 3700 W Seltice Way
Coeur D Alene, ID 83814-8921 - Phone
- (208) 620-5255
- Fax
- (208) 664-9217
- NPI assigned
- Apr 13, 2007
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 12
Medicare Care Compare profile
- Specialty
- Mental Health Counselor
- Education
- Other, 2006
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Dirne Health Centers Inc
Practice addresses (Care Compare)
3700 W Seltice Way
Coeur D Alene, ID 83814-8921
Phone (208) 620-5255
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241007002395 | ID | Practitioner - Mental Health Counselor | 0648613323 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCPC-4251 | ID | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dirne Health Centers, Inc. | Counselor | Current |
Accepting new patients |
| Dirne Health Centers, Inc. | Counselor | Current |
Accepting new patients |
| Dirne Health Centers, Inc. | Counselor | Current | Accepting new patients |
| Dirne Health Centers Inc | Counselor | Past |
Accepting new patients |
Locations
3700 W Seltice Way
Coeur D Alene, ID 83814
Phone (208) 620-5250
2205 N Ironwood Pl
Ste A
Coeur D Alene, ID 83814
Phone (208) 664-8347
2205 N Ironwood Pl
Coeur D Alene, ID 83814
Phone (208) 292-0303
1090 W Park Pl
Coeur D Alene, ID 83814
Phone (208) 215-2005
740 McKinley Ave
Kellogg, ID 83837
Phone (208) 783-1267
925 E Polston Ave
Post Falls, ID 83854
Phone (208) 618-0787
16760 N Highway 41
Rathdrum, ID 83858
Phone (208) 687-5627
120 S 13th St
St Maries, ID 83861
Phone (208) 245-4363
Interoperability endpoints
- kimberly.johnson.1@16899.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Yes | ||
| Professional Counselor | 101YP2500X | LCPC-4251 | ID |
Addresses
Primary practice location
3700 W Seltice Way
Coeur D Alene, ID 83814-8921
Mailing address
PO Box 1387
Hayden, ID 83835-1387
Phone (208) 664-8347
Other names
- Kimberly Anne Breckenridge/Kreaman
Other providers in Coeur D Alene, ID
- Julie Michelle Johnson
- Juliette Johnson
- Justine Johnson
- Kaesha Johnson
- Kevin M Johnson
- Maryjayne Mabrey Johnson
- Robert John Johnson
- Simone Johnson
- Tyler W Johnson
- Vallenthia Ann Johnson
All providers in Coeur D Alene, ID · Mental Health Counselor in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 4, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.