Provider Demographics
NPI:1437212941
Name:JOHNSON, KEVIN R (LCSW)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:R
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 SAINT JAMES LN
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-6743
Mailing Address - Country:US
Mailing Address - Phone:435-225-4357
Mailing Address - Fax:
Practice Address - Street 1:652 S MEDICAL CENTER DR STE 340
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7049
Practice Address - Country:US
Practice Address - Phone:435-251-6250
Practice Address - Fax:435-251-6251
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5962642-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical