Active NPI
Kristine Johansson Yells, PH.D., LCSW
- Clinical Social Worker
- Texarkana, TX
National Provider Identifier
1538673140
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- Practice address
- 1400 College Dr Ste 204
Texarkana, TX 75503-3575 - Phone
- (903) 791-1110
- Fax
- (903) 791-9353
- NPI assigned
- Nov 20, 2017
- Last updated
- Nov 30, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 8590-C | AR | |
| Social Worker | 104100000X | 64902 | TX | |
| Clinical Social Worker | 1041C0700X | NU | Primary |
Addresses
Primary practice location
1400 College Dr Ste 204
Texarkana, TX 75503-3575
Mailing address
PO Box 1326
Marshall, TX 75671-1326
Phone (903) 927-3782
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 64902 | Other | TX | LICENSE |
| 8590-C | Other | AR | LICENSE |
Other names 1
- Kristine Johansson
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8590-C | AR | MD | Social Worker |
| 64902 | TX | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1511136000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1669766400000",
"number": "1538673140",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1326",
"city": "MARSHALL",
"state": "TX",
"postal_code": "756711326",
"telephone_number": "903-927-3782",
"fax_number": "903-927-1764"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1400 COLLEGE DR STE 204",
"city": "TEXARKANA",
"state": "TX",
"postal_code": "755033575",
"telephone_number": "903-791-1110",
"fax_number": "903-791-9353"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YELLS",
"first_name": "KRISTINE",
"middle_name": "JOHANSSON",
"credential": "PH.D., LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-11-20",
"last_updated": "2022-11-30",
"certification_date": "2022-11-30",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "AR",
"license": "8590-C",
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "TX",
"license": "64902",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "64902",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "8590-C",
"state": "AR"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "KRISTINE",
"last_name": "JOHANSSON",
"credential": "PH.D., LCSW",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Texarkana, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.