Provider Demographics
NPI:1225300957
Name:JOHNSON, SHIRLEY KAY (LICENSED GRIEF COUNS)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:KAY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LICENSED GRIEF COUNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 RUBY CIR
Mailing Address - Street 2:
Mailing Address - City:GILBERTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19525-8414
Mailing Address - Country:US
Mailing Address - Phone:484-680-5098
Mailing Address - Fax:610-367-0101
Practice Address - Street 1:1000 GROSSER RD STE 2A
Practice Address - Street 2:
Practice Address - City:GILBERTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19525-9225
Practice Address - Country:US
Practice Address - Phone:484-680-5098
Practice Address - Fax:610-367-0101
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-26
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACERTIFIED GRIEF COUN101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health