Provider Demographics
NPI:1518492784
Name:JOHNSON, KYLE ANN (LCPC, LAC)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCPC, LAC
Other - Prefix:
Other - First Name:KYLE
Other - Middle Name:ANN
Other - Last Name:LUCAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:560 RAVEN RUN APT 1
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-8524
Mailing Address - Country:US
Mailing Address - Phone:406-579-5039
Mailing Address - Fax:
Practice Address - Street 1:25 S EWING ST STE 511
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-5732
Practice Address - Country:US
Practice Address - Phone:406-996-1034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-25
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT37585101YP2500X
MTLAC-LIC-3436101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)