Active NPI
Kenneth Lorenzo Johnson, MA, PH.D., MLP
- Clinical Psychologist
- Southgate, MI
National Provider Identifier
1225305931
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6361001548
- Practice address
- 13101 Allen Rd
Southgate, MI 48195-2216 - Phone
- (734) 785-7700
- NPI assigned
- Nov 23, 2011
- Last updated
- Nov 6, 2024
- Sex
- Male
- Sole proprietor
- No
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 | 6361001548 | MI | Primary |
Addresses
Primary practice location
13101 Allen Rd
Southgate, MI 48195-2216
Mailing address
7605 W 7 Mile Rd
Detroit, MI 48221-2163
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
- Credentials
- Master of Arts, Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6361001548 | MI | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1322006400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1730851200000",
"number": "1225305931",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7605 W 7 MILE RD",
"city": "DETROIT",
"state": "MI",
"postal_code": "482212163"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13101 ALLEN RD",
"city": "SOUTHGATE",
"state": "MI",
"postal_code": "481952216",
"telephone_number": "734-785-7700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "KENNETH",
"middle_name": "LORENZO",
"name_prefix": "Dr.",
"credential": "MA, PH.D., MLP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-11-23",
"last_updated": "2024-11-06",
"certification_date": "2024-11-06",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6361001548",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Southgate, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 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.