Active NPI
Carol S Johnson, LMFT
- Marriage & Family Therapist
- Albuquerque, NM
National Provider Identifier
1316077696
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 203
- Practice address
- 630 Haines Ave NW
Albuquerque, NM 87102-1226 - Phone
- (505) 268-5611
- NPI assigned
- Mar 6, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 578 | CO | |
| Marriage & Family Therapist | 106H00000X | 310445 | TN | |
| Marriage & Family Therapist | 106H00000X | 203 | WY | Primary |
Addresses
Primary practice location
630 Haines Ave NW
Albuquerque, NM 87102-1226
Mailing address
5 Lane LN
Sheridan, WY 82801-8630
Phone (307) 675-4120
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 98588290 | Medicaid | NM |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 310445 | TN | MD | Marriage & Family Therapist |
| 578 | CO | MD | Podiatrist |
| 203 | WY | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Metro Treatment of New Mexico LP | Past | Accepting new patients | |
| Metro Treatment of New Mexico LP | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Methadone Clinic
- Albuquerque, NM
- NPI 1144437294
-
- Methadone Clinic
- Albuquerque, NM
- NPI 1710512199
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173139200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1675382400000",
"number": "1316077696",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5 LANE LN",
"city": "SHERIDAN",
"state": "WY",
"postal_code": "828018630",
"telephone_number": "307-675-4120"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "630 HAINES AVE NW",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871021226",
"telephone_number": "505-268-5611"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "CAROL",
"middle_name": "S",
"credential": "LMFT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-06",
"last_updated": "2023-02-03",
"certification_date": "2023-02-03",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CO",
"license": "578",
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "TN",
"license": "310445",
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "WY",
"license": "203",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "98588290",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.