Jaclyn Rachel Johnson, MA, LPCC, LADC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

CC04220 Issued in MN

Practice address

4100 Berkshire LN N
Plymouth, MN 55446-3813

Phone

(763) 203-9568

NPI assigned

Oct 8, 2021

Last updated

Aug 5, 2026By 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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

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.

• Collaborative Counseling LLC

  • Mental Health Counselor
  • Maple Grove, MN
  • NPI 1598034324
  Medicare reassignment NPD
• Nuway Mental Health Clinic

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Minneapolis, MN
  • NPI 1013608405
  NPD (past)
• Optum Behavioral Care of Colorado PC

  dba Care Counseling of Minnesota

  • Psychologist
  • Edina, MN
  • NPI 1336967561
  NPD (past)

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

{
    "created_epoch": "1633651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785888000000",
    "number": "1447912316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4100 BERKSHIRE LN N",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554463813",
            "telephone_number": "763-203-9568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 BERKSHIRE LN N",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554463813",
            "telephone_number": "763-203-9568"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7430 Wentworth Ave",
            "address_purpose": "LOCATION",
            "city": "Richfield",
            "state": "MN",
            "postal_code": "554234133",
            "country_code": "US",
            "telephone_number": "612-488-0040",
            "fax_number": "833-973-4055",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JACLYN",
        "middle_name": "RACHEL",
        "credential": "MA, LPCC, LADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-08",
        "last_updated": "2026-08-05",
        "certification_date": "2026-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "306063",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "CC04220",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jaclyn.johnson@care-clinics.com",
            "affiliation": "N",
            "endpointDescription": "Work",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "4100 Berkshire Ln N",
            "city": "Plymouth",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554463813",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Andrew Ryan Johnson, DC
• Brett Ryser Johnson, CRNA
• Carolyn Johnson, LPN
• Courtney Marie Johnson
• David S. Johnson, MD
• Jashae Johnson
• Julia Aletta Johnson
• Kelly Bernice Johnson
• Lindsay Johnson, PSYD
• Owen W Johnson, RPH

• Professional Counselor in Plymouth, MN
• Providers in Plymouth, MN by specialty
• Professional Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.