Provider Demographics
NPI:1437427531
Name:MARY K. JOHNSON, L.M.H.P., P.C.
Entity Type:Organization
Organization Name:MARY K. JOHNSON, L.M.H.P., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:K
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMHP, PC
Authorized Official - Phone:402-917-6191
Mailing Address - Street 1:5514 N 162ND ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-3731
Mailing Address - Country:US
Mailing Address - Phone:402-917-6191
Mailing Address - Fax:402-397-4268
Practice Address - Street 1:820 S 75TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4623
Practice Address - Country:US
Practice Address - Phone:402-917-6191
Practice Address - Fax:402-397-4268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2616101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty