Gary Gene Johnson, PH.D, LP, LMFT

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LP1794 Issued in MN

Practice address

430 Oak Grove Street
Suite 414
Minneapolis, MN 55403-3242

Phone

(612) 872-9072

Fax

(612) 872-8605

NPI assigned

May 2, 2007

Sex

Male

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

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Calm-Clinic for Attention, Learning, and Memor

  • Psychologist
  • Minneapolis, MN
  • NPI 1053614131
  NPD (past) Authorized official
• Loring Family Therapy Serices Inc

  • Marriage & Family Therapist
  • Minneapolis, MN
  • NPI 1568432904
  NPD (past) Authorized official

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

{
    "created_epoch": "1178064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1245452291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "430 OAK GROVE STREET",
            "address_2": "SUITE 414",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554033242",
            "telephone_number": "612-872-9072",
            "fax_number": "612-872-8605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 OAK GROVE STREET",
            "address_2": "SUITE 414",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554033242",
            "telephone_number": "612-872-9072",
            "fax_number": "612-872-8605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "GARY",
        "middle_name": "GENE",
        "name_prefix": "Dr.",
        "credential": "PH.D, LP, LMFT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-02",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP1794",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Johnson
• Emily Lindsey Johnson
• Emma Grace Johnson
• Eric Matthew Johnson, M.D.
• Evan James Johnson, MD
• Grace Johnson
• Haley Lee Johnson, PA-C
• Heather S Johnson, PHARMD
• Heather Sue Johnson, PHARMD
• Heather Trisha Johnson, LICSW

• Clinical Psychologist in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.