Jacky Catherine Johnson, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

LMFT-15214 Issued in AZ

Practice address

5262 N 148TH Ave
Litchfield Park, AZ 85340-2843

Phone

(503) 484-5190

Fax

(623) 322-1838

NPI assigned

Dec 16, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Jacky Catherine Hicks Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1450224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611187200000",
    "number": "1407211626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5262 N 148TH AVE",
            "city": "LITCHFIELD PARK",
            "state": "AZ",
            "postal_code": "853402843",
            "telephone_number": "503-484-5190",
            "fax_number": "623-322-1838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5262 N 148TH AVE",
            "city": "LITCHFIELD PARK",
            "state": "AZ",
            "postal_code": "853402843",
            "telephone_number": "503-484-5190",
            "fax_number": "623-322-1838"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JACKY",
        "middle_name": "CATHERINE",
        "credential": "LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-12-16",
        "last_updated": "2021-01-21",
        "certification_date": "2021-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "AZ",
            "license": "LMFT-15214",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACKY",
            "last_name": "HICKS",
            "middle_name": "CATHERINE",
            "credential": "LMFT, LPC, CADC II",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Marriage & Family Therapist in Litchfield Park, AZ
• Providers in Litchfield Park, AZ by specialty
• Marriage & Family Therapist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 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.