Provider Demographics
NPI:1326237645
Name:JOHNSON, LINDA POGORZELSKI (LPC, MED)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:POGORZELSKI
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPC, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 OLD HIGHWAY 63 S
Mailing Address - Street 2:SUITE 311
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-6081
Mailing Address - Country:US
Mailing Address - Phone:573-424-9052
Mailing Address - Fax:
Practice Address - Street 1:1827 CLIFF DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6069
Practice Address - Country:US
Practice Address - Phone:573-424-9052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCS 002355101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional