Provider Demographics
NPI:1588017008
Name:JOHNSON, CARA (MS, MFT)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS, MFT
Other - Prefix:
Other - First Name:CARA
Other - Middle Name:
Other - Last Name:MIELKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LLC, MS, LAMFT
Mailing Address - Street 1:4803 HIGHWAY 10 NW
Mailing Address - Street 2:
Mailing Address - City:SAUK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56379-9509
Mailing Address - Country:US
Mailing Address - Phone:320-290-9504
Mailing Address - Fax:
Practice Address - Street 1:38460 LINCOLN TRL
Practice Address - Street 2:
Practice Address - City:NORTH BRANCH
Practice Address - State:MN
Practice Address - Zip Code:55056-5834
Practice Address - Country:US
Practice Address - Phone:651-277-4283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3424106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist