Provider Demographics
NPI:1033273404
Name:JOHNSON, THERESE ANN (LMHC)
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2955 80TH AVE SE STE 206
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-2975
Mailing Address - Country:US
Mailing Address - Phone:206-232-0623
Mailing Address - Fax:206-232-0626
Practice Address - Street 1:2955 80TH AVE SE STE 206
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-2975
Practice Address - Country:US
Practice Address - Phone:206-232-0623
Practice Address - Fax:206-232-0626
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00004816101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health