Edlicia Johnson, AMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

208.001028 Issued in IL

Practice address

1502 W Chicago Ave
Chicago, IL 60642-5236

Phone

(312) 339-8604

NPI assigned

Jan 12, 2022

Sex

Female

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Spring Practices PLLC

  dba The Chicago EMDR Center

  • Multi-Specialty Clinic/Center
  • Champaign, IL
  • NPI 1669910766
  NPD (past)

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

{
    "created_epoch": "1641945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666224000000",
    "number": "1427709336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2105 HOME ST",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604339534",
            "telephone_number": "815-999-2253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1502 W CHICAGO AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606425236",
            "telephone_number": "312-339-8604"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "211 N Hammes Ave Ste 101",
            "address_purpose": "LOCATION",
            "city": "Joliet",
            "state": "IL",
            "postal_code": "604358113",
            "country_code": "US",
            "telephone_number": "815-242-6081",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "EDLICIA",
        "credential": "AMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-12",
        "last_updated": "2022-10-20",
        "certification_date": "2022-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "IL",
            "license": "208.001028",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Derron Johnson Jr., LCPC
• Dominique Latrice Johnson, DO
• Donna Johnson, PHLEBOTOMIST
• Dwayne Arra Johnson Sr., LCSW
• Ebony Talise Johnson, BSN-RN
• Elizabeth Johnson
• Elizabeth Anne Johnson, DTH
• Elli Clare Johnson, MD
• Emilie Johnson, MD
• Emily Diane Johnson, APRN, CNP

• Marriage & Family Therapist in Chicago, IL
• Providers in Chicago, IL by specialty
• Marriage & Family Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2022; 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.