Devan W.W. Johnson, LAC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

1976 Issued in ND

Practice address

2126 Vista Ave, Arnegard, ND 58835
Arnegard, ND 58835

Phone

(701) 586-3300

NPI assigned

May 15, 2024

Last updated

May 15, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Providence House LLC

  • Substance Abuse Rehabilitation Facility
  • Arnegard, ND
  • NPI 1184367567
  NPD

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

{
    "created_epoch": "1715731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715731200000",
    "number": "1710736459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1521 EMERALD RIDGE RD APT 111",
            "city": "WATFORD CITY",
            "state": "ND",
            "postal_code": "588548512",
            "telephone_number": "701-500-2194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2126 VISTA AVE, ARNEGARD, ND 58835",
            "city": "ARNEGARD",
            "state": "ND",
            "postal_code": "58835",
            "telephone_number": "701-586-3300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "DEVAN",
        "middle_name": "W.W.",
        "credential": "LAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-05-15",
        "last_updated": "2024-05-15",
        "certification_date": "2024-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "ND",
            "license": "1976",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Owen Hamre
• Tasha Jeanmarie Kelly, LAC
• LGND Rehab & Performance PLLC
• Lindsey Nicole Page, LAC
• Anita Ann Pedersen, FNP-BC
• Providence House LLC

• Addiction (Substance Use Disorder) Counselor in Arnegard, ND
• Providers in Arnegard, ND by specialty
• Addiction (Substance Use Disorder) Counselor in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2024; 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.