Provider Demographics
NPI:1053450866
Name:JOHNSON, JOHNATHAN ANTHONY (LPC)
Entity Type:Individual
Prefix:MR
First Name:JOHNATHAN
Middle Name:ANTHONY
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 HICKORY HILL LN STE 3
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-1931
Mailing Address - Country:US
Mailing Address - Phone:615-601-0580
Mailing Address - Fax:615-777-3360
Practice Address - Street 1:2525C LEBANON PIKE STE 202
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-2418
Practice Address - Country:US
Practice Address - Phone:615-601-0580
Practice Address - Fax:615-777-3360
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2098101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
45-5143984OtherIRS
TN1528040Medicaid