Provider Demographics
NPI:1245200310
Name:JOHNSON, DEBBIE ANN (MED LMHC)
Entity Type:Individual
Prefix:MRS
First Name:DEBBIE
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MED LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 N 1ST ST
Mailing Address - Street 2:SUITE 54
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-2859
Mailing Address - Country:US
Mailing Address - Phone:360-336-5465
Mailing Address - Fax:360-336-5086
Practice Address - Street 1:117 N 1ST ST
Practice Address - Street 2:SUITE 54
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-2859
Practice Address - Country:US
Practice Address - Phone:360-336-5465
Practice Address - Fax:360-336-5086
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00005158101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA35593OtherREGENCE RIDER #