Kathleen Jackson Johnson, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

1165-10-15-21A Issued in ND

Practice address

1202 Westrac Dr S Ste 200
Fargo, ND 58103-2356

Phone

(701) 280-9545

NPI assigned

Nov 20, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Kathleen Jackson Former name

Medicare fee-for-service enrollment

Enrolled in ND

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

Specialty

Mental Health Counselor

Education

Other, 2021

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Catholic Charities North Dakota

  • Voluntary or Charitable Agency
  • Fargo, ND
  • NPI 1619927290
  Medicare reassignment NPD
• Pediatric Therapy Partners, Inc.

  • Occupational Therapist
  • Thief River Falls, MN
  • NPI 1457479958

  ND, Professional

  Medicare reassignment NPD
• Nexus-Path Family Healing

  • Psychiatric Residential Treatment Facility
  • Fargo, ND
  • NPI 1811572886
  NPD

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

{
    "created_epoch": "1637366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724889600000",
    "number": "1780341156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1505 5TH AVE S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581031539",
            "telephone_number": "701-232-8905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1202 WESTRAC DR S STE 200",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581032356",
            "telephone_number": "701-280-9545"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2701 12th Ave S",
            "address_purpose": "LOCATION",
            "city": "Fargo",
            "state": "ND",
            "postal_code": "581038753",
            "country_code": "US",
            "telephone_number": "701-451-4900",
            "fax_number": "651-925-0057",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KATHLEEN",
        "middle_name": "JACKSON",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-11-20",
        "last_updated": "2024-08-29",
        "certification_date": "2024-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "ND",
            "license": "1165-10-15-21A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATHLEEN",
            "last_name": "JACKSON",
            "credential": "MS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kaitlyn Johnson, PT, DPT
• Kara J Johnson, MD
• Kari M Johnson, LPCC
• Kasey E Johnson, D.O.
• Katherine Renee Johnson, LMT
• Keiley Shae Johnson, RD
• Kelly Johnson
• Kelly Johnson
• Kinsey Lyn Johnson, NP
• Kirsten Johnson

• Professional Counselor in Fargo, ND
• Providers in Fargo, ND by specialty
• Professional Counselor in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.