Provider Demographics
NPI:1114187135
Name:JOHNSON, MARY MARGARET (MA,LMFT LPC, MHSP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:MARGARET
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA,LMFT LPC, MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6583 WINDMILL DR
Mailing Address - Street 2:
Mailing Address - City:COLLEGE GROVE
Mailing Address - State:TN
Mailing Address - Zip Code:37046-1480
Mailing Address - Country:US
Mailing Address - Phone:901-831-2438
Mailing Address - Fax:
Practice Address - Street 1:109 HOLIDAY CT STE A1
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-3046
Practice Address - Country:US
Practice Address - Phone:615-392-0913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-12
Last Update Date:2020-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2433101YP2500X
MSTO459106H00000X
TN1104106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional