Provider Demographics
NPI:1164555207
Name:JOHNSON, JULIE B (LPCC)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:B
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:K
Other - Last Name:BOSWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCA
Mailing Address - Street 1:2707 BRECKENRIDGE ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1385
Mailing Address - Country:US
Mailing Address - Phone:270-702-0147
Mailing Address - Fax:270-215-4011
Practice Address - Street 1:2707 BRECKENRIDGE ST
Practice Address - Street 2:SUITE 4
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1385
Practice Address - Country:US
Practice Address - Phone:270-702-0147
Practice Address - Fax:270-215-4011
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY105826101YP2500X
KY169044221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100285950Medicaid
KY30615058Medicaid