Active NPI
Derreck Johnson, LLPC, DP-C
- Professional Counselor
- Owosso, MI
National Provider Identifier
1669858478
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 6401015200
- Practice address
- 1555 Industrial Dr
Owosso, MI 48867-9775 - Phone
- (989) 723-6791
- Fax
- (989) 725-5061
- NPI assigned
- Aug 4, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | |||
| Professional Counselor | 101YP2500X | 6401015200 | MI | Primary |
Addresses
Primary practice location
1555 Industrial Dr
Owosso, MI 48867-9775
Mailing address
1321 S Fayette St
Saginaw, MI 48602-1447
Phone (989) 792-8000
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6401015200 | MI | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1438646400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1507766400000",
"number": "1669858478",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1321 S FAYETTE ST",
"city": "SAGINAW",
"state": "MI",
"postal_code": "486021447",
"telephone_number": "989-792-8000",
"fax_number": "989-792-8445"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1555 INDUSTRIAL DR",
"city": "OWOSSO",
"state": "MI",
"postal_code": "488679775",
"telephone_number": "989-723-6791",
"fax_number": "989-725-5061"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "DERRECK",
"credential": "LLPC, DP-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-08-04",
"last_updated": "2017-10-12",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MI",
"license": "6401015200",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Owosso, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.