Provider Demographics
NPI:1497804447
Name:JOHNSON, LAURA ANN (MA, LMHC)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3224 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-5902
Mailing Address - Country:US
Mailing Address - Phone:253-318-6890
Mailing Address - Fax:253-422-2969
Practice Address - Street 1:1614 S MILDRED ST
Practice Address - Street 2:SUITE B
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98465-1613
Practice Address - Country:US
Practice Address - Phone:253-534-3401
Practice Address - Fax:253-564-9451
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00010808101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health