Provider Demographics
NPI:1477599249
Name:JOHNSON, LISA JAYNES (LMFT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:JAYNES
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 CARLISLE BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-1209
Mailing Address - Country:US
Mailing Address - Phone:505-288-2162
Mailing Address - Fax:
Practice Address - Street 1:3214 PURDUE PL NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2124
Practice Address - Country:US
Practice Address - Phone:505-288-2162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1710106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMZ7949Medicaid
NMNM100184OtherVALUE OPTIONS NM
NM112391OtherVALUE OPTIONS PPO
NM87726OtherUNITED HEALTH PLAN
NM10001443OtherLOVELACE HEALTH PLAN
NMNM02JE00OtherBLUE CROSS BLUE SHEILD ID