Nicolette R Johnson, LPCC; LADC/LMAC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

2723 Issued in MN

Practice address

103 Doctors Park
Saint Cloud, MN 56303-1207

Phone

(320) 855-6557

Fax

(320) 238-7456

NPI assigned

Feb 9, 2017

Last updated

Aug 4, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 19, 2024 through Jan 19, 2028

Medicare enrollment (NPD)

Not enrolled

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.

• Authentic Self Therapy PLLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Saint Cloud, MN
  • NPI 1255013504
  NPD Authorized official
• Village Family Service Center

  dba The Village Family Service Center

  • Substance Abuse Rehabilitation Facility
  • Fargo, ND
  • NPI 1952679318

  Addiction (Substance Use Disorder)

  NPD (past)

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

{
    "created_epoch": "1486598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754265600000",
    "number": "1427596543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 DOCTORS PARK",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563031207",
            "telephone_number": "320-855-6557",
            "fax_number": "320-238-7456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 DOCTORS PARK",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563031207",
            "telephone_number": "320-855-6557",
            "fax_number": "320-238-7456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "NICOLETTE",
        "middle_name": "R",
        "credential": "LPCC; LADC/LMAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-02-09",
        "last_updated": "2025-08-04",
        "certification_date": "2025-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "2723",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Ann Crosetto Johnson, OTR/L
• Megan Johnson, CCC-SLP
• Mindy Lee Johnson, RN
• Molly J Johnson
• Nicole E Johnson, MS, CGC
• Olivia Grace Johnson
• Paula Jean Johnson, LMFT
• Rachel Johnson, ATC
• Randall L Johnson, LMFT
• Raychael Marie Johnson

• Mental Health Counselor in Saint Cloud, MN
• Providers in Saint Cloud, MN by specialty
• Mental Health Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.