Provider Demographics
NPI:1477316339
Name:JOHNSON, SHEYENNE (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:SHEYENNE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4528 SANTA ELENA ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-7350
Mailing Address - Country:US
Mailing Address - Phone:505-391-9771
Mailing Address - Fax:
Practice Address - Street 1:4528 SANTA ELENA ST UNIT B
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-7350
Practice Address - Country:US
Practice Address - Phone:505-391-9771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-02
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCBT20230979101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty