NPIMap

Organization Active NPI

Teens Against Gang Violence

Doing business as Teens Advocating a Global Vision

  • Addiction (Substance Use Disorder) Counselor
  • Boston, MA
National Provider Identifier
1649516220
Registry record updated Feb 16, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
40 Issued in MA
Legal business name
TEENS AGAINST GANG VIOLENCE
Doing business as
Teens Advocating a Global Vision
Practice address
735 Morrissey Blvd
Boston, MA 02122-3406
Phone
(617) 365-0637
Fax
(617) 282-9659
NPI assigned
Dec 30, 2012
Last updated
Feb 16, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2015

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

Authorized official

Name
Ulric R Johnson, LMHC, LMFT, LADCI RCNPI 1083908594
Title
Owner
Phone
61733650637

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YA0400X 40 MA Primary
Mental Health CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YM0800X 265 MA
Marriage & Family TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 106H00000X 149 MA

Addresses

Primary practice location

735 Morrissey Blvd
Boston, MA 02122-3406

Mailing address

2 Moody St
Boston, MA 02124-3507
Phone (617) 365-0637

Other names 1

  • TEENS ADVOCATING A GLOBAL VISION Doing business as

National Provider Directory

National Provider Directory

Locations

735 William T Morrissey Blvd
Boston, MA 02122
Phone (617) 282-9659

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1356825600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424044800000",
    "number": "1649516220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 MOODY ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021243507",
            "telephone_number": "617-365-0637",
            "fax_number": "617-282-9659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "735 MORRISSEY BLVD",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021223406",
            "telephone_number": "617-365-0637",
            "fax_number": "617-282-9659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TEENS AGAINST GANG VIOLENCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-30",
        "last_updated": "2015-02-16",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "ULRIC",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "61733650637",
        "authorized_official_credential": "LMHC, LMFT, LADCI RC"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MA",
            "license": "40",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "MA",
            "license": "265",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "MA",
            "license": "149",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TEENS ADVOCATING A GLOBAL VISION",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Boston, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2015; 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.