Active NPI
Renese M. Johnson, LPC
- Mental Health Counselor
- Round Rock, TX
National Provider Identifier
1821417049
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 65174
- Practice address
- 110 N Interstate 35 Ste 315 PMB 3311
Round Rock, TX 78681-5520 - Phone
- (512) 270-1918
- Fax
- (512) 727-7720
- NPI assigned
- Apr 15, 2014
- Last updated
- Oct 31, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 65174 | TX | |
| Mental Health Counselor | 101YM0800X | 65174 | TX | Primary |
| Professional Counselor | 101YP2500X | 65174 | TX |
Addresses
Primary practice location
110 N Interstate 35 Ste 315 PMB 3311
Round Rock, TX 78681-5520
Mailing address
382 Leona LN
Bay City, TX 77414-2096
Phone (512) 270-1918
Other practice location 1
2012 Redwing Way
Round Rock, TX 78664-7123
Phone (512) 379-1827
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821417049 | Medicaid | TX |
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 |
|---|---|---|---|
| 65174 | TX | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Teladoc Health Medical Group, P.a. | Counselor | Current | Accepting new patients |
| Courageous Counseling PLLC | Counselor | Past | Accepting new patients |
Interoperability endpoints
- renesejohnson@tdh.allscriptsdirect.net
Organizations & group practices 2
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.
-
- Family Medicine Physician
- Lewisville, TX
- NPI 1245403567
Counselor
-
- Mental Health Counselor
- Pflugerville, TX
- NPI 1215504964
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1397520000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1730332800000",
"number": "1821417049",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "382 LEONA LN",
"city": "BAY CITY",
"state": "TX",
"postal_code": "774142096",
"telephone_number": "512-270-1918",
"fax_number": "512-727-7720"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 N INTERSTATE 35 STE 315 PMB 3311",
"city": "ROUND ROCK",
"state": "TX",
"postal_code": "786815520",
"telephone_number": "512-270-1918",
"fax_number": "512-727-7720"
}
],
"practiceLocations": [
{
"address_1": "2012 Redwing Way",
"address_purpose": "LOCATION",
"city": "Round Rock",
"state": "TX",
"postal_code": "786647123",
"country_code": "US",
"telephone_number": "512-379-1827",
"fax_number": "512-727-7720",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JOHNSON",
"first_name": "RENESE",
"middle_name": "M.",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-04-15",
"last_updated": "2024-10-31",
"certification_date": "2024-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "TX",
"license": "65174",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "TX",
"license": "65174",
"primary": true
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "65174",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1821417049",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Round Rock, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 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.