{
"Npi": {
"NPI": "1194940486",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "JOHNSON",
"FirstName": "KIMBERLY",
"MiddleName": "ANNE",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "LCPC",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "BRECKENRIDGE/KREAMAN",
"OtherFirstName": "KIMBERLY",
"OtherMiddleName": "ANNE",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "LPC, NCC",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "PO BOX 1387",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HAYDEN",
"MailingAddressStateName": "ID",
"MailingAddressPostalCode": "83835-1387",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "208-664-8347",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3700 W SELTICE WAY",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "COEUR D ALENE",
"PracticeLocationAddressStateName": "ID",
"PracticeLocationAddressPostalCode": "83814-8921",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "208-620-5255",
"PracticeLocationAddressFaxNumber": "208-664-9217",
"EnumerationDate": "04/13/2007",
"LastUpdateDate": "03/04/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "101YM0800X",
"TaxonomyName": "Mental Health Counselor",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "101YP2500X",
"TaxonomyName": "Professional Counselor",
"LicenseNumber": "LCPC-4251",
"LicenseNumberStateCode": "ID",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}