Mary Alison Johnson, R1462450322

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Practice address

17822 Beach Blvd Ste 278
Huntington Beach, CA 92647-7180

Phone

(143) 753-7957

Fax

(714) 375-3796

NPI assigned

Mar 28, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Interoperability endpoints

• Direct secure messaging: maryj@socialmodel.com

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.

• Social Model Recovery Systems, Inc.

  • Substance Abuse Rehabilitation Facility
  • Los Angeles, CA
  • NPI 1124306386
  NPD (past)
• Social Model Recovery Systems, Inc.

  • Community/Behavioral Health Agency
  • Covina, CA
  • NPI 1497834089
  NPD (past)

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

{
    "created_epoch": "1648425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722384000000",
    "number": "1861142184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "453 S INDIANA ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900633908",
            "telephone_number": "323-266-7726",
            "fax_number": "323-266-7742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17822 BEACH BLVD STE 278",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926477180",
            "telephone_number": "143-753-7957",
            "fax_number": "714-375-3796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MARY",
        "middle_name": "ALISON",
        "credential": "R1462450322",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-03-28",
        "last_updated": "2024-07-31",
        "certification_date": "2024-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SUBSTANCE ABUSE",
            "identifier": "101YA0400X",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Maryj@socialmodel.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "453 S Indiana St",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900633908",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Isrialle Johnson
• Jayla Johnson
• Kenneth S Johnson, M.D.
• Lauren Johnson, SLP
• Marissa Iona Johnson
• Megan Johnson
• Michelle Johnson, LMFT
• Randall Lee Johnson, MD
• Christopher Johnston, DPT
• Karly Johnston

• Addiction (Substance Use Disorder) Counselor in Huntington Beach, CA
• Providers in Huntington Beach, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 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.

Verify at the official NPI Registry.