Provider Demographics
NPI:1093863441
Name:JOHNSON, JULIE HICKS (LPCC)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:HICKS
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42276-1401
Mailing Address - Country:US
Mailing Address - Phone:270-731-0000
Mailing Address - Fax:270-731-0001
Practice Address - Street 1:151 W 5TH ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:KY
Practice Address - Zip Code:42276-1401
Practice Address - Country:US
Practice Address - Phone:270-731-0000
Practice Address - Fax:270-731-0001
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2023-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY0599101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional