Provider Demographics
NPI:1396228516
Name:JOHNSON, JENNY LYNN (MA, LPC, LAC)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:LYNN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA, LPC, LAC
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:LYNN
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2057 BROOKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-1135
Mailing Address - Country:US
Mailing Address - Phone:719-290-8860
Mailing Address - Fax:
Practice Address - Street 1:801 N WEBER ST STE 103
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-5927
Practice Address - Country:US
Practice Address - Phone:719-345-7095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-13
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACB.0008305101YA0400X
COACD.0001918101YA0400X
COLPC.0017586101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty