Provider Demographics
NPI:1164490132
Name:JOHNSON, HARLAN (LMFT, LCPC)
Entity Type:Individual
Prefix:MR
First Name:HARLAN
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LMFT, LCPC
Other - Prefix:
Other - First Name:HARLAN
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT, LCPC
Mailing Address - Street 1:852 LAKEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61102-1228
Mailing Address - Country:US
Mailing Address - Phone:815-968-5433
Mailing Address - Fax:
Practice Address - Street 1:852 LAKEWOOD DR
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61102-1228
Practice Address - Country:US
Practice Address - Phone:815-968-5433
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist