Jennifer Lyn Johnson, MS LLP

Primary specialty

PsychologistTaxonomy code 103T00000X

License

6301010450 Issued in MI

Practice address

13938 M Gibraltar Rd
Gibraltar, MI 48173-9711

Phone

(313) 484-3211

Fax

(313) 710-4520

NPI assigned

Apr 18, 2013

Last updated

Aug 26, 2026By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1999

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Conscious Mind Psychiatry of Michigan

  dba Conscious Mind Psychiatry

  • Psychiatric/Mental Health Nurse Practitioner
  • Gibraltar, MI
  • NPI 1053284737
  Medicare reassignment NPD
• Pure Psychiatry of Michigan PLLC

  • Physician Assistant
  • Wayne, MI
  • NPI 1831701671
  Medicare reassignment

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

{
    "created_epoch": "1366243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787702400000",
    "number": "1407290711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13938 M GIBRALTAR RD",
            "city": "GIBRALTAR",
            "state": "MI",
            "postal_code": "481739711",
            "telephone_number": "313-484-3211",
            "fax_number": "313-710-4520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13938 M GIBRALTAR RD",
            "city": "GIBRALTAR",
            "state": "MI",
            "postal_code": "481739711",
            "telephone_number": "313-484-3211",
            "fax_number": "313-710-4520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JENNIFER",
        "middle_name": "LYN",
        "credential": "MS LLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-04-18",
        "last_updated": "2026-08-26",
        "certification_date": "2026-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6301010450",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Conscious Mind Psychiatry of Michigan (Conscious Mind Psychiatry)
• Tim Charles Desano
• Gibraltar Pharmacy Inc (Gibraltar Sav-Mor Pharmacy #16)
• Donovan Matthew Haddix, RPH
• Warren Michael Horbal, D.D.S.
• Elizabeth Sarah Jordan
• Nida Kased
• Stephanie Lauren Marl, PMHNP-BC
• Karley Mason
• Mibell Home Health Care Agency LLC

• Psychologist in Gibraltar, MI
• Providers in Gibraltar, MI by specialty
• Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.