Provider Demographics
NPI:1265853089
Name:JOHANSEN, DARREN (LPC)
Entity Type:Individual
Prefix:
First Name:DARREN
Middle Name:
Last Name:JOHANSEN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 W 400 N
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-4663
Mailing Address - Country:US
Mailing Address - Phone:801-369-8702
Mailing Address - Fax:
Practice Address - Street 1:310 W 400 N
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-4663
Practice Address - Country:US
Practice Address - Phone:801-369-8702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-20
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5498400-6009101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional