Active NPI
Michael Bruce Johnson, PHD
- Psychologist
- Spicewood, TX
National Provider Identifier
1629215728
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 13-21P
- Practice address
- 2406 Sunset Vista Cir
Spicewood, TX 78669-2094 - Phone
- (512) 228-2126
- NPI assigned
- Jan 12, 2009
- Last updated
- Oct 23, 2022
- 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 6
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 13-21P | AR | Primary |
| Counseling Psychologist | 103TC1900X | PSY003246 | GA | |
| Counseling Psychologist | 103TC1900X | 13-21P | AR | |
| Exercise & Sports Psychologist | 103TE1100X | PSY003246 | GA | |
| Exercise & Sports Psychologist | 103TE1100X | 13-21P | AR | |
| Group Psychotherapy Psychologist | 103TP2701X | PSY003246 | GA |
Addresses
Primary practice location
2406 Sunset Vista Cir
Spicewood, TX 78669-2094
Mailing address
2406 Sunset Vista Cir
Spicewood, TX 78669-2094
Phone (512) 228-2126
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 |
|---|---|---|---|
| 13-21P | AR | MD | Counseling Psychologist |
| PSY003246 | GA | MD | Group Psychotherapy Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1231718400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1666483200000",
"number": "1629215728",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2406 SUNSET VISTA CIR",
"city": "SPICEWOOD",
"state": "TX",
"postal_code": "786692094",
"telephone_number": "512-228-2126"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2406 SUNSET VISTA CIR",
"city": "SPICEWOOD",
"state": "TX",
"postal_code": "786692094",
"telephone_number": "512-228-2126"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "MICHAEL",
"middle_name": "BRUCE",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-01-12",
"last_updated": "2022-10-23",
"certification_date": "2021-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "AR",
"license": "13-21P",
"primary": true
},
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "GA",
"license": "PSY003246",
"primary": false
},
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "AR",
"license": "13-21P",
"primary": false
},
{
"code": "103TE1100X",
"taxonomy_group": "",
"desc": "Psychologist, Exercise & Sports",
"state": "GA",
"license": "PSY003246",
"primary": false
},
{
"code": "103TE1100X",
"taxonomy_group": "",
"desc": "Psychologist, Exercise & Sports",
"state": "AR",
"license": "13-21P",
"primary": false
},
{
"code": "103TP2701X",
"taxonomy_group": "",
"desc": "Psychologist, Group Psychotherapy",
"state": "GA",
"license": "PSY003246",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Spicewood, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 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.