Provider Demographics
NPI:1366679672
Name:JOHNSON, RACHEL ANNE (MA, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:ANNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:LYNN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1972
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-5030
Mailing Address - Country:US
Mailing Address - Phone:360-280-1335
Mailing Address - Fax:
Practice Address - Street 1:4936 BALUSTRADE BLVD SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98513-4168
Practice Address - Country:US
Practice Address - Phone:360-280-1335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-12
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60443848101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health