Provider Demographics
NPI:1467118554
Name:JOHANNISSON, HALLIE (LCSW)
Entity Type:Individual
Prefix:
First Name:HALLIE
Middle Name:
Last Name:JOHANNISSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:579 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-4923
Mailing Address - Country:US
Mailing Address - Phone:720-257-3810
Mailing Address - Fax:
Practice Address - Street 1:579 E 9TH ST
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-4923
Practice Address - Country:US
Practice Address - Phone:720-257-3810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-12
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.000012771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical