Active NPI
Mark A Johnson Sr., LCSW, LCDC
- Clinical Social Worker
- North Las Vegas, NV
National Provider Identifier
1811238587
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 97416
- Practice address
- 6900 N Pecos Rd
North Las Vegas, NV 89086-4400 - Phone
- (702) 791-9000
- NPI assigned
- Mar 6, 2013
- 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 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 14357 | TX | |
| Clinical Social Worker | 1041C0700X | 60924 | TX | |
| Clinical Social Worker | 1041C0700X | 089.0134242 | VT | |
| Clinical Social Worker | 1041C0700X | 97416 | CA | Primary |
Addresses
Primary practice location
6900 N Pecos Rd
North Las Vegas, NV 89086-4400
Mailing address
PO Box 336685
North Las Vegas, NV 89033-6685
Phone (702) 524-0626
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 |
|---|---|---|---|
| 60924 | TX | MD | Clinical Social Worker |
| 089.0134242 | VT | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| VA Palo Alto Healthcare System | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- VA Clinic/Center
- San Jose, CA
- NPI 1003206244
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1362528000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1702598400000",
"number": "1811238587",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 336685",
"city": "NORTH LAS VEGAS",
"state": "NV",
"postal_code": "890336685",
"telephone_number": "702-524-0626"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6900 N PECOS RD",
"city": "NORTH LAS VEGAS",
"state": "NV",
"postal_code": "890864400",
"telephone_number": "702-791-9000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "MARK",
"middle_name": "A",
"name_prefix": "Mr.",
"name_suffix": "Sr.",
"credential": "LCSW, LCDC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-03-06",
"last_updated": "2023-12-15",
"certification_date": "2023-12-15",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "TX",
"license": "14357",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "TX",
"license": "60924",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "VT",
"license": "089.0134242",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "97416",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.