Individual provider Active NPI

Carol S Johnson, LMFT

  • Marriage & Family Therapist
  • Albuquerque, NM
National Provider Identifier
1316077696
Registry record updated Feb 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
203 Issued in WY
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

Updated by the provider on Feb 3, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
98588290MedicaidNM

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

LicenseStateTypeSpecialty
310445TNMDMarriage & Family Therapist
578COMDPodiatrist
203WYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Metro Treatment of New Mexico LP PastSince Feb 8, 2023 Accepting new patients
Metro Treatment of New Mexico LP PastSince Feb 8, 2023 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.

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.

Verify at the official NPI Registry.