Provider Demographics
NPI:1336104314
Name:JOHNSON, MARK D (LMHC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3473 E BETHEL LN
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47408-9386
Mailing Address - Country:US
Mailing Address - Phone:812-272-4846
Mailing Address - Fax:
Practice Address - Street 1:320 W 8TH ST
Practice Address - Street 2:SUITE 110
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-3748
Practice Address - Country:US
Practice Address - Phone:812-333-9800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health