Nicole M. Johnson, PSYD, LP, LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

NICOLE M. JOHNSON, PSYD, LP, LLC

Doing business as

River Vale Psychology Clinic

Practice address

200 E Travelers TRL Ste 205
Burnsville, MN 55337-4191

Phone

(612) 249-0269

Fax

(612) 249-8540

NPI assigned

May 27, 2020

Organization subpart

No

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

Authorized official

Name

Dr. Nicole M. Johnson PSYD LP, LP

Title

Owner/Licensed Psychologist

Phone

(612) 249-0287

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• River Vale Psychology Clinic Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Madeline Gould, LPCC

  • Professional Counselor
  • Lakeville, MN
  • NPI 1043166036
  NPD (past)

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

{
    "created_epoch": "1590537600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599782400000",
    "number": "1649893587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 E TRAVELERS TRL STE 205",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553374191",
            "telephone_number": "612-249-0269",
            "fax_number": "612-249-8540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 E TRAVELERS TRL STE 205",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553374191",
            "telephone_number": "612-249-0269",
            "fax_number": "612-249-8540"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 E Travelers Trl Ste 205",
            "address_purpose": "LOCATION",
            "city": "Burnsville",
            "state": "MN",
            "postal_code": "553374191",
            "country_code": "US",
            "telephone_number": "952-454-8269",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NICOLE M. JOHNSON, PSYD, LP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-27",
        "last_updated": "2020-09-11",
        "certification_date": "2020-09-11",
        "status": "A",
        "authorized_official_last_name": "LP",
        "authorized_official_first_name": "NICOLE M. JOHNSON",
        "authorized_official_middle_name": "PSYD",
        "authorized_official_title_or_position": "OWNER/LICENSED PSYCHOLOGIST",
        "authorized_official_telephone_number": "612-249-0287",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "LP"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI II",
            "identifier": "1649893587",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@rivervalepsychology.com",
            "affiliation": "N",
            "endpointDescription": "Email address",
            "address_1": "1609 Country Rd 42 W",
            "address_2": "#188",
            "city": "Burnsville",
            "state": "MN",
            "country_code": "US",
            "postal_code": "55306",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "River Vale Psychology Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "River Vale Psychology Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sarah Nguyen, D.C.
• Son Hong Nguyen
• William Nichols, DPM
• Deborah Simson Nicholson, MD
• Andrew Nickels, M.D.
• Nicole Schumann PSYD, LP, LLC
• Paul Arthur Nielsen, PT
• Bethany Lila Niemela, DIPL. OM, L.AC.
• Elizabeth Catherine Niemuth, PT
• Amira Nihlawi, PA-C

• Clinical Psychologist in Burnsville, MN
• Providers in Burnsville, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.