Provider Demographics
NPI:1053078832
Name:B JOHNSON, LLC
Entity Type:Organization
Organization Name:B JOHNSON, LLC
Other - Org Name:BETHANY JOHNSON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:234-444-5055
Mailing Address - Street 1:606 E MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-3689
Mailing Address - Country:US
Mailing Address - Phone:234-444-5055
Mailing Address - Fax:812-265-5028
Practice Address - Street 1:606 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-4708
Practice Address - Country:US
Practice Address - Phone:812-265-4151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-29
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1053078832Medicaid
4731973OtherAETNA