Active NPI
Ken Ferrell Johnson Jr., PSYD
- Mental Health Counselor
- Amelia Island, FL
National Provider Identifier
1841414547
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 5548
- Practice address
- 5422 1St Coast Hwy
Ste 119
Amelia Island, FL 32034-5423 - Phone
- (386) 235-3831
- Fax
- (904) 432-7088
- NPI assigned
- Apr 12, 2007
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 5548 | FL | Primary |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 5548 | FL | |
| Psychologist | 103T00000X | 5548 | FL |
Addresses
Primary practice location
5422 1St Coast Hwy
Ste 119
Amelia Island, FL 32034-5423
Mailing address
5422 1St Coast Hwy
Ste 119
Amelia Island, FL 32034-5423
Phone (386) 235-3831
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Previously, effective Sep 3, 2024 through Sep 3, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5548 | FL | MD | Athletic Trainer |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Counseling & Psychological Services LLC | Addiction (Substance Use Disorder) | 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.
-
- Counselor
- Amelia Island, FL
- NPI 1306192513
Addiction (Substance Use Disorder)
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176336000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1421798400000",
"number": "1841414547",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5422 1ST COAST HWY",
"address_2": "STE 119",
"city": "AMELIA ISLAND",
"state": "FL",
"postal_code": "320345423",
"telephone_number": "386-235-3831",
"fax_number": "904-432-7088"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5422 1ST COAST HWY",
"address_2": "STE 119",
"city": "AMELIA ISLAND",
"state": "FL",
"postal_code": "320345423",
"telephone_number": "386-235-3831",
"fax_number": "904-432-7088"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "KEN",
"middle_name": "FERRELL",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-12",
"last_updated": "2015-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "FL",
"license": "5548",
"primary": true
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "FL",
"license": "5548",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "FL",
"license": "5548",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Amelia Island, FL
- Family Counseling & Psychological Services LLC
- Genesis Eldercare Rehabilitation Services LLC
- Genesis Eldercare Rehabilitation Services LLC
- Jayde Marie Gray, DC
- Gregory N. Smith MD PA
- Michele Elizabeth Johnson, LMHC
- Emily Jones, ATC, LAT
- Live Long Well Care, LLC (Live Long Well Care of Nassau County)
- Daniel Mills Jr., OTR/L
- Monarch Academy for Neurodivergent Youth and Young Adults L.L.C.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.