Madison Samantha Johnson

Primary specialty

CounselorTaxonomy code 101Y00000X

License

CG61177156 Issued in WA

Practice address

711 State Ave NE
Olympia, WA 98506-3984

Phone

(360) 481-4565

NPI assigned

Jul 14, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1594684800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622505600000",
    "number": "1609494830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 STATE AVE NE",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985063984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 STATE AVE NE",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985063984",
            "telephone_number": "360-481-4565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MADISON",
        "middle_name": "SAMANTHA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-07-14",
        "last_updated": "2021-06-01",
        "certification_date": "2021-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "WA",
            "license": "CG61177156",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "TherapyNotes",
            "affiliation": "Y",
            "affiliationName": "The Evergreen State College Wellness Center",
            "address_1": "525 Tullis St NE",
            "city": "Olympia",
            "state": "WA",
            "country_code": "US",
            "postal_code": "985064239",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kelly Johnson
• Kelvie A Johnson, M.D.
• Laura Johnson, LMP
• Lauren Beth Johnson, RDN
• Lisa Ann Johnson, M.D.
• Melanie Johnson, RN
• Michelle Johnson
• Mollie Eileen Johnson, LMT
• Owen Johnson, MD
• Randelle Johnson, ARNP

• Counselor in Olympia, WA
• Providers in Olympia, WA by specialty
• Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2021; 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.