Active NPI
Matthew Johansen, MS, LCPC, QSUDP
- Mental Health Counselor
- Meridian, ID
National Provider Identifier
1487066320
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- LCPC-6475
- Practice address
- 2131 S Bonito Way
Meridian, ID 83642-1659 - Phone
- (208) 202-4729
- NPI assigned
- May 27, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | LCPC-6475 | ID | Primary |
Addresses
Primary practice location
2131 S Bonito Way
Meridian, ID 83642-1659
Mailing address
6407 W Robertson Dr
Boise, ID 83709-2176
Phone (208) 836-8247
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCPC-6475 | ID | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1401148800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1550793600000",
"number": "1487066320",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6407 W ROBERTSON DR",
"city": "BOISE",
"state": "ID",
"postal_code": "837092176",
"telephone_number": "208-836-8247"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2131 S BONITO WAY",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "836421659",
"telephone_number": "208-202-4729"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHANSEN",
"first_name": "MATTHEW",
"credential": "MS, LCPC, QSUDP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-05-27",
"last_updated": "2019-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "ID",
"license": "LCPC-6475",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Meridian, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.