Provider Demographics
NPI:1376976787
Name:JOHNSON, COLLEEN DEPUYDT (LCSW)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:DEPUYDT
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:COLLEEN
Other - Middle Name:DEPUYDT
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3536 SUNNY LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59912-9043
Mailing Address - Country:US
Mailing Address - Phone:406-250-3845
Mailing Address - Fax:
Practice Address - Street 1:305 1ST AVE. W
Practice Address - Street 2:
Practice Address - City:COLUMBIA FALLS
Practice Address - State:MT
Practice Address - Zip Code:59912
Practice Address - Country:US
Practice Address - Phone:406-892-4406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTSWP-LCSW-LIC-45741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical