Jessica Johnson
Individual provider Active NPI Professional Counselor · Princeton, KY
NPI 1629737101 · NPPES record last updated Mar 5, 2025
Key facts
- NPI
- 1629737101
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 294045 (KY)
- Practice address
- 1350 US Highway 62 W
Princeton, KY 42445-6106 - Phone
- (270) 365-2008
- NPI assigned
- Dec 13, 2021
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241015002962 | KY | Practitioner - Mental Health Counselor | 0345772315 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 294045 | KY | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lifeskills, Inc. | Current |
Accepting new patients | |
| Lifeskills, Inc. | Current |
Accepting new patients |
Locations
8324 Eagle Way
Chicago, IL 60678
608 Happy Valley Rd
Glasgow, KY 42141
Phone (270) 651-8379
735 North Dr
Hopkinsville, KY 42240
Phone (270) 886-5163
1350 US Highway 62 W
Princeton, KY 42445
Phone (270) 365-2008
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 294045 | KY | |
| Professional Counselor | 101YP2500X | 294045 | KY | Yes |
Addresses
Primary practice location
1350 US Highway 62 W
Princeton, KY 42445-6106
Mailing address
PO Box 614
Hopkinsville, KY 42241-0614
Other providers in Princeton, KY
- Michael Edmond Howard
- Bradley Joseph Hutchins
- Insession, PLLC
- J Martin Lane Eyecare Center
- Mary Hall James
- Ashley Jones
- Noah Kennaday
- Kenneth Clay Kennedy
- Kentucky CVS Pharmacy, L.L.C.
- Kelsee Lee
All providers in Princeton, KY · Professional Counselor in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 5, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.