Broddrick Ronzell Johnson, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

8875 Issued in LA

Practice address

102 Iris St
Thibodaux, LA 70301-4939

Phone

(985) 414-5275

NPI assigned

Jul 15, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Start Corporation

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Houma, LA
  • NPI 1700156866
  Medicare reassignment NPD
• Start Corporation

  • Federally Qualified Health Center (FQHC)
  • Mandeville, LA
  • NPI 1346712957
  NPD

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

{
    "created_epoch": "1594771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713744000000",
    "number": "1770191801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 IRIS ST",
            "city": "THIBODAUX",
            "state": "LA",
            "postal_code": "703014939",
            "telephone_number": "985-414-5275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 IRIS ST",
            "city": "THIBODAUX",
            "state": "LA",
            "postal_code": "703014939",
            "telephone_number": "985-414-5275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "BRODDRICK",
        "middle_name": "RONZELL",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-07-15",
        "last_updated": "2024-04-22",
        "certification_date": "2024-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "LA",
            "license": "8875",
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John C Hildenbrand IV LLC
• John J Jones Jr MD Apmc
• Alexis Johnson, MS
• Amy M. Johnson, RN
• Blair Johnson, BSW
• Christopher L Johnson
• De'Ja Amber'Leigh Johnson
• Faith Johnson
• Jaslyn Johnson
• Kendall Johnson, BS

• Professional Counselor in Thibodaux, LA
• Providers in Thibodaux, LA by specialty
• Professional Counselor in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.