Provider Demographics
NPI:1326195975
Name:JOHNSON, MITA M (LPC, LMFT, CAC III)
Entity Type:Individual
Prefix:
First Name:MITA
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPC, LMFT, CAC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4297
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80437-4297
Mailing Address - Country:US
Mailing Address - Phone:303-808-8466
Mailing Address - Fax:303-674-6957
Practice Address - Street 1:12600 W COLFAX AVENUE
Practice Address - Street 2:SUITE B 420 ASPEN GROVE COUNSELING CENTER
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215
Practice Address - Country:US
Practice Address - Phone:303-922-0077
Practice Address - Fax:303-674-6957
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6450101YA0400X
CO4215101YP2500X
CO764106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist