Provider Demographics
NPI:1225651730
Name:JOHNSON, LISA MICHELE (LMHCA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MICHELE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2615 S 14TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-2627
Mailing Address - Country:US
Mailing Address - Phone:253-579-6756
Mailing Address - Fax:
Practice Address - Street 1:2615 S 14TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-2627
Practice Address - Country:US
Practice Address - Phone:253-579-6756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-19
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61038293101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health