Provider Demographics
NPI:1205029006
Name:JOHNSON, KATHLEEN ANNE (LMHC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ANNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4907 NW 48TH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33319-3636
Mailing Address - Country:US
Mailing Address - Phone:305-490-1778
Mailing Address - Fax:
Practice Address - Street 1:5440 N STATE ROAD 7 STE 216
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33319-2900
Practice Address - Country:US
Practice Address - Phone:305-490-1778
Practice Address - Fax:888-972-1653
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 7109101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ126BOtherBCBSF