Provider Demographics
NPI:1235402652
Name:JOHNSON, JULIE (MA, NCC, TLMHC, LPHA)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA, NCC, TLMHC, LPHA
Other - Prefix:MS
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:MACDONALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, NCC, TLMHC, LPHA
Mailing Address - Street 1:403 4TH ST
Mailing Address - Street 2:
Mailing Address - City:GRUNDY CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:50638-1730
Mailing Address - Country:US
Mailing Address - Phone:319-239-8522
Mailing Address - Fax:
Practice Address - Street 1:307 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-5796
Practice Address - Country:US
Practice Address - Phone:641-352-7000
Practice Address - Fax:866-496-4073
Is Sole Proprietor?:No
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001458101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health