Jacqualine Tia Johnson

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

1209 W Tokay St Ste 5
Lodi, CA 95240-3845

Phone

(209) 331-2070

NPI assigned

Nov 13, 2017

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

Practice roles

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

• County of San Joaquin

  • Multi-Specialty Clinic/Center
  • Manteca, CA
  • NPI 1417407636
  NPD (past)

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

{
    "created_epoch": "1510531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1510531200000",
    "number": "1477066520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1209 W TOKAY ST STE 5",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952403845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1209 W TOKAY ST STE 5",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952403845",
            "telephone_number": "209-331-2070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JACQUALINE",
        "middle_name": "TIA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-11-13",
        "last_updated": "2017-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John F. Kiraly III, MD
• John Kiraly MD
• John Lu DDS PC
• Alexandria Johnson, LVN
• Amanda Johnson, OTR/L
• Joseph Kevin Johnson, MD
• Ross M Johnson, DDS
• Selena Marie Johnson
• Kimberly Lynn Jones, P.T. ASSISTANT
• Stacey Ann Jones

• Mental Health Counselor in Lodi, CA
• Providers in Lodi, CA by specialty
• Mental Health Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2017; 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.