NPIMap

Organization Active NPI

Shannon Johnson LLC

Doing business as Family Wellness Center LLC

  • Marriage & Family Therapist
  • Valparaiso, IN
National Provider Identifier
1295326064
Registry record updated Jan 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
Legal business name
SHANNON JOHNSON LLC
Doing business as
Family Wellness Center LLC
Practice address
1551 Sturdy Rd Ste 3
Valparaiso, IN 46383-7829
Phone
(219) 531-0111
Fax
(219) 224-4133
NPI assigned
Feb 3, 2021
Last updated
Jan 18, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Shannon S Johnson, LMFTNPI 1972859478
Title
Owner
Phone
(219) 531-0111

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X NU
Marriage & Family Therapist 106H00000X NU Primary

Addresses

Primary practice location

1551 Sturdy Rd Ste 3
Valparaiso, IN 46383-7829

Mailing address

1551 Sturdy Rd Ste 3
Valparaiso, IN 46383-7829
Phone (219) 531-0111

Other names 1

  • Family Wellness Center LLC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240405002159 IN Part B Supplier - Clinic/Group Practice 5294173522 Receives reassigned benefits from 3 practitioners
Practice locations: Valparaiso, IN

National Provider Directory

National Provider Directory

Locations

1551 Sturdy Rd
Ste 3
Valparaiso, IN 46383
Phone (219) 531-0111

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1612310400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705536000000",
    "number": "1295326064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1551 STURDY RD STE 3",
            "city": "VALPARAISO",
            "state": "IN",
            "postal_code": "463837829",
            "telephone_number": "219-531-0111",
            "fax_number": "219-224-4133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1551 STURDY RD STE 3",
            "city": "VALPARAISO",
            "state": "IN",
            "postal_code": "463837829",
            "telephone_number": "219-531-0111",
            "fax_number": "219-224-4133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHANNON JOHNSON LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-03",
        "last_updated": "2024-01-18",
        "certification_date": "2024-01-18",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "219-531-0111",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Wellness Center LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Family Wellness Center LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Valparaiso, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.