Provider Demographics
NPI:1275953150
Name:MARILEE JOHNSON-GEARY, PLLC
Entity Type:Organization
Organization Name:MARILEE JOHNSON-GEARY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH & ADDICTION COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARILEE
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:JOHNSON-GEARY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-MH, QMHP, LAC
Authorized Official - Phone:605-201-1191
Mailing Address - Street 1:1321 E 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-3733
Mailing Address - Country:US
Mailing Address - Phone:605-999-6162
Mailing Address - Fax:605-942-7300
Practice Address - Street 1:115 E HAVENS AVE
Practice Address - Street 2:STE 100
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-4461
Practice Address - Country:US
Practice Address - Phone:605-999-6162
Practice Address - Fax:605-942-7300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-18
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC-MH2111101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1457457889Medicaid