Provider Demographics
NPI:1114287349
Name:JOHNSON, BENJAMIN EVERETT (MA, PLPC, PLMFT)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:EVERETT
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MA, PLPC, PLMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 929
Mailing Address - Street 2:ATTN: FAMILY PLUS
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71273-0929
Mailing Address - Country:US
Mailing Address - Phone:504-920-5319
Mailing Address - Fax:
Practice Address - Street 1:1000 CLAY ST
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70062-6734
Practice Address - Country:US
Practice Address - Phone:504-920-5319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-22
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA101YP2500X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional