Provider Demographics
NPI:1457457889
Name:JOHNSON-GEARY, MARILEE KAY (LPC-MH,QMHP,LAC)
Entity Type:Individual
Prefix:MRS
First Name:MARILEE
Middle Name:KAY
Last Name:JOHNSON-GEARY
Suffix:
Gender:F
Credentials:LPC-MH,QMHP,LAC
Other - Prefix:MS
Other - First Name:MARILEE
Other - Middle Name:KAY
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC-MH LAC QMHP
Mailing Address - Street 1:1321 E 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-3733
Mailing Address - Country:US
Mailing Address - Phone:605-999-6162
Mailing Address - Fax:605-942-7300
Practice Address - Street 1:115 E HAVENS AVE
Practice Address - Street 2:STE 100
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-4462
Practice Address - Country:US
Practice Address - Phone:605-999-6162
Practice Address - Fax:605-942-7300
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD06051267101YA0400X
SD2111101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1457457889Medicaid