Active NPI
Jashaun Johnson
- Addiction (Substance Use Disorder) Counselor
- Novato, CA
National Provider Identifier
1497124937
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- R111241214
- Practice address
- 111 Bishop CT
Novato, CA 94945-3401 - Phone
- (707) 853-8829
- Fax
- (415) 492-0834
- NPI assigned
- Sep 15, 2015
- Last updated
- Sep 15, 2015
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | R111241214 | CA | Primary |
Addresses
Primary practice location
111 Bishop CT
Novato, CA 94945-3401
Mailing address
111 Bishop CT
Novato, CA 94945-3401
Phone (707) 853-8829
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| B6844483 | Medicaid | CA |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R111241214 | CA | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1442275200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1442275200000",
"number": "1497124937",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "111 BISHOP CT",
"city": "NOVATO",
"state": "CA",
"postal_code": "949453401",
"telephone_number": "707-853-8829",
"fax_number": "415-492-0834"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "111 BISHOP CT",
"city": "NOVATO",
"state": "CA",
"postal_code": "949453401",
"telephone_number": "707-853-8829",
"fax_number": "415-492-0834"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "JASHAUN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-09-15",
"last_updated": "2015-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CA",
"license": "R111241214",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "B6844483",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Novato, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.