Provider Demographics
NPI:1164713954
Name:JOHNSON, PATRICIA K (MS)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:K
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4338 IDLEWILD LN
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-4722
Mailing Address - Country:US
Mailing Address - Phone:317-582-0861
Mailing Address - Fax:
Practice Address - Street 1:4338 IDLEWILD LN
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46033-4722
Practice Address - Country:US
Practice Address - Phone:317-582-0861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001297A101YP2500X
IN34003192A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional