Benton Kurt Johnson II, PHD, LCPC, LMHC, NCC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

180-006524 Issued in IL

Practice address

2424 40TH Ave Apt 6
Moline, IL 61265-7215

Phone

(309) 269-3100

Fax

(888) 243-3903

NPI assigned

Apr 18, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 5

Addresses

Other identifiers 1

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.

• Ephphatha Consulting Services, Inc.

  • Mental Health Counselor
  • Moline, IL
  • NPI 1184938730
  NPD (past) Authorized official

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

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627171200000",
    "number": "1326264060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2424 40TH AVE",
            "address_2": "SUITE 5",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612657215",
            "telephone_number": "309-269-3100",
            "fax_number": "888-243-3903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2424 40TH AVE APT 6",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612657215",
            "telephone_number": "309-269-3100",
            "fax_number": "888-243-3903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "BENTON",
        "middle_name": "KURT",
        "name_prefix": "Dr.",
        "name_suffix": "II",
        "credential": "PHD, LCPC, LMHC, NCC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-18",
        "last_updated": "2021-07-25",
        "certification_date": "2021-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IL",
            "license": "180006524",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IA",
            "license": "001063",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180006524",
            "primary": false
        },
        {
            "code": "222Q00000X",
            "taxonomy_group": "",
            "desc": "Developmental Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "180-006524",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EI PROVIDER #",
            "identifier": "208164344",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• JKCD Healthcare Consulting, LLC
• Joc Doc. Inc.
• John Gnatovich DDS LTD
• John Van Straten DO SC
• John Williams DDS, PC
• Brad Johnson
• Jennifer Robin Johnson
• John P Johnson, PA-C
• Sarah Elizabeth Johnson, CMA
• Suzanne Ellen Johnson, BCABA

• Mental Health Counselor in Moline, IL
• Providers in Moline, IL by specialty
• Mental Health Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2021; 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.