Provider Demographics
NPI:1073252086
Name:JOHNSON, KATHERINE (PLPC, NCC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PLPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 CASA URBANO DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-5943
Mailing Address - Country:US
Mailing Address - Phone:601-260-5291
Mailing Address - Fax:
Practice Address - Street 1:208 KEY DR STE C
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-7378
Practice Address - Country:US
Practice Address - Phone:601-760-2050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP-0822101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health