Provider Demographics
NPI:1043492747
Name:JOHNSON, ANN P (MED,LAC)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:P
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MED,LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 S WADSWORTH BLVD
Mailing Address - Street 2:BLDG. 2, SUITE 205
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-4300
Mailing Address - Country:US
Mailing Address - Phone:303-989-9577
Mailing Address - Fax:303-989-9890
Practice Address - Street 1:777 S WADSWORTH BLVD
Practice Address - Street 2:BLDG. 2, SUITE 205
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-4300
Practice Address - Country:US
Practice Address - Phone:303-989-9577
Practice Address - Fax:303-989-9890
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO40101YA0400X
CO0101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health