Provider Demographics
NPI:1558829838
Name:MOUNTAINJOHNSON, KAREN (MA, LPCC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:MOUNTAINJOHNSON
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:MOUNTAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPCC
Mailing Address - Street 1:1155 NORTHLAND DR
Mailing Address - Street 2:
Mailing Address - City:MENDOTA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55120-1288
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1155 NORTHLAND DR
Practice Address - Street 2:
Practice Address - City:MENDOTA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55120-1288
Practice Address - Country:US
Practice Address - Phone:612-268-5951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-06
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00152101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional