Provider Demographics
NPI:1356634141
Name:JOHNSON, RACHEL MARIE (LCPC)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:MARIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2299 CHRISTOPHER DR
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-1410
Mailing Address - Country:US
Mailing Address - Phone:224-532-1336
Mailing Address - Fax:
Practice Address - Street 1:311 E MAIN ST
Practice Address - Street 2:ST. 205
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-4855
Practice Address - Country:US
Practice Address - Phone:224-532-1336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-26
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180007469101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1083634901OtherBLUE CROSS BLUE SHIELD