Provider Demographics
NPI:1164801858
Name:JOHNSON, SHILA SUEANN (LAC, LCPC)
Entity Type:Individual
Prefix:
First Name:SHILA
Middle Name:SUEANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LAC, LCPC
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 51023
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59105-1023
Mailing Address - Country:US
Mailing Address - Phone:406-839-3804
Mailing Address - Fax:
Practice Address - Street 1:1643 24TH ST W
Practice Address - Street 2:SUITE 309
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-2677
Practice Address - Country:US
Practice Address - Phone:406-839-3804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-27
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1398101YA0400X
MT12199101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)