Active NPI
Rebecca Marie Johnson, LMFT
- Mental Health Counselor
- Corte Madera, CA
National Provider Identifier
1508116237
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 21 Tamal Vista Blvd
Suite 210
Corte Madera, CA 94925-1130 - Phone
- (415) 820-1612
- Fax
- (415) 747-8479
- NPI assigned
- Sep 10, 2012
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Primary |
Addresses
Primary practice location
21 Tamal Vista Blvd
Suite 210
Corte Madera, CA 94925-1130
Mailing address
21 Tamal Vista Blvd
Suite 210
Corte Madera, CA 94925-1130
Phone (415) 820-1612
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 79769 | Other | CA | LICENSED MARRIAGE & FAMILY THERPAIST NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2024 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 79769 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1347235200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1419984000000",
"number": "1508116237",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21 TAMAL VISTA BLVD",
"address_2": "SUITE 210",
"city": "CORTE MADERA",
"state": "CA",
"postal_code": "949251130",
"telephone_number": "415-820-1612",
"fax_number": "415-747-8479"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21 TAMAL VISTA BLVD",
"address_2": "SUITE 210",
"city": "CORTE MADERA",
"state": "CA",
"postal_code": "949251130",
"telephone_number": "415-820-1612",
"fax_number": "415-747-8479"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "REBECCA",
"middle_name": "MARIE",
"name_prefix": "Ms.",
"credential": "LMFT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-09-10",
"last_updated": "2014-12-31",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSED MARRIAGE & FAMILY THERPAIST NUMBER",
"identifier": "79769",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Corte Madera, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.