Matthew Johnson, MA LPCC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

CC00100 Issued in MN

Practice address

219 SE Main St Ste 400
Minneapolis, MN 55414

Phone

(612) 886-2524

Fax

(612) 886-2538

NPI assigned

Feb 9, 2010

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

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

Practice roles

Locations

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.

• The Healing Hideout LLC

  • Clinical Social Worker
  • Edina, MN
  • NPI 1922824879
  Medicare reassignment NPD
• Nystrom & Associates, LTD

  • Clinical Social Worker
  • New Brighton, MN
  • NPI 1396750188
  NPD
• Stone Arch Psychology and Health Services

  • Clinical Psychologist
  • Minneapolis, MN
  • NPI 1124398607
  NPD (past)

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

{
    "created_epoch": "1265673600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528761600000",
    "number": "1265764641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "219 SE MAIN ST STE 400",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554142151",
            "telephone_number": "612-886-2524",
            "fax_number": "612-886-2538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "219 SE MAIN ST STE 400",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "55414",
            "telephone_number": "612-886-2524",
            "fax_number": "612-886-2538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MATTHEW",
        "credential": "MA LPCC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-02-09",
        "last_updated": "2018-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "CC00100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mark Alan Johnson, D.C.
• Mark Herbert Johnson, M.D.
• Mary Katharine Johnson, APRN CNP
• Masha Johnson
• Matisse Lela Johnson
• Maxine Johnson, MA. LPCC
• Mbuotidem Johnson
• Meredyth Ann Johnson, CD (DONA)
• Michael Timm Johnson, D.C.
• Michelle Lee Johnson

• Professional Counselor in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Professional Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.