Provider Demographics
NPI:1154863918
Name:LINDSEYJOHNSONLMFT
Entity Type:Organization
Organization Name:LINDSEYJOHNSONLMFT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:612-444-3785
Mailing Address - Street 1:10030 BLAISDELL AVE S
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55420-4836
Mailing Address - Country:US
Mailing Address - Phone:612-444-3785
Mailing Address - Fax:612-223-6735
Practice Address - Street 1:6636 CEDAR AVE S
Practice Address - Street 2:SUITE 380
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-2705
Practice Address - Country:US
Practice Address - Phone:612-444-3785
Practice Address - Fax:612-223-6735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-10
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2245251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1689812299OtherNPI INDIVIDUAL