Provider Demographics
NPI:1285196014
Name:JOHNSON, AMBER LYNN (LLBSW)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:LYNN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LLBSW
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:LYNN
Other - Last Name:GUTOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLBSW
Mailing Address - Street 1:1651 E NICKERSON AVE
Mailing Address - Street 2:
Mailing Address - City:BENTON HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49022-2469
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1651 E NICKERSON AVE
Practice Address - Street 2:
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-2469
Practice Address - Country:US
Practice Address - Phone:269-983-5833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician