Individual provider Active NPI

Shitonda Johnson, LCSW

  • Clinical Social Worker
  • Houston, TX
National Provider Identifier
1619425279
Registry record updated Nov 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
103427 Issued in TX
Practice address
10303 Northwest Fwy Ste 318
Houston, TX 77092-8221
Phone
(713) 425-6412
NPI assigned
Sep 13, 2016
Last updated
Nov 14, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 14, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 103427 TX Primary

Addresses

Primary practice location

10303 Northwest Fwy Ste 318
Houston, TX 77092-8221

Mailing address

PO Box 14416
Houston, TX 77221-4416
Phone (713) 425-6412

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231204003189 TX Practitioner - Clinical Social Worker 5294183026 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
103427TXMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Keturah Health, LLC CurrentSince Nov 1, 2025 Accepting new patients

Locations

750 E US Highway 80
Ste 200612
Forney, TX 75126

2455 Robinson Rd
#100
Grand Prairie, TX 75051
Phone (469) 626-8195

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1473724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699920000000",
    "number": "1619425279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 14416",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "772214416",
            "telephone_number": "713-425-6412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10303 NORTHWEST FWY STE 318",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770928221",
            "telephone_number": "713-425-6412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "SHITONDA",
        "name_prefix": "Miss",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-09-13",
        "last_updated": "2023-11-14",
        "certification_date": "2023-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "103427",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

Verify at the official NPI Registry.