Provider Demographics
NPI:1467469221
Name:JOHNSON, JILL ANN (MS LMFT)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 DEWAR DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-6200
Mailing Address - Country:US
Mailing Address - Phone:307-382-3010
Mailing Address - Fax:307-382-6881
Practice Address - Street 1:4000 DEWAR DR.
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-6200
Practice Address - Country:US
Practice Address - Phone:307-382-3010
Practice Address - Fax:307-382-6881
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLMFT042106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist