Provider Demographics
NPI:1316038805
Name:JOHNSON, KAI MARK (LMHC, LMFT)
Entity Type:Individual
Prefix:MR
First Name:KAI
Middle Name:MARK
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LMHC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4123 BURNHAM DR
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-1054
Mailing Address - Country:US
Mailing Address - Phone:808-203-8463
Mailing Address - Fax:
Practice Address - Street 1:2008 B NORTH 3RD ST
Practice Address - Street 2:RM 313
Practice Address - City:JOINT BASE LEWIS MCCORD
Practice Address - State:WA
Practice Address - Zip Code:98433
Practice Address - Country:US
Practice Address - Phone:253-967-1410
Practice Address - Fax:253-967-1411
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP 60121912101YA0400X
FLCAP 321101YA0400X
FLMH 8210101YM0800X
WALH 60125435101YM0800X
WA60270424106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist