Provider Demographics
NPI:1487662110
Name:JOHNSON, JULIE A (MA LCPC)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:A
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2836 W MINNESOTA
Mailing Address - Street 2:
Mailing Address - City:BLUE ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60406
Mailing Address - Country:US
Mailing Address - Phone:773-383-7033
Mailing Address - Fax:
Practice Address - Street 1:2656 W. MONTROSE
Practice Address - Street 2:SUITE 113
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618
Practice Address - Country:US
Practice Address - Phone:773-383-7033
Practice Address - Fax:773-920-3316
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180004543101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health