Provider Demographics
NPI:1437120680
Name:JOHNS, MARK J (LCPC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:JOHNS
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3948 N SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-2935
Mailing Address - Country:US
Mailing Address - Phone:773-502-8252
Mailing Address - Fax:773-564-4175
Practice Address - Street 1:3948 N SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-2935
Practice Address - Country:US
Practice Address - Phone:773-502-8252
Practice Address - Fax:773-564-4175
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-001399103T00000X
IL180.001399101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180.001399Medicaid