Provider Demographics
NPI:1588809396
Name:JOHNSON, AMY LYNNE (LMHC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYNNE
Last Name:JOHNSON
Suffix:
Gender:
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2708 ALT 19 STE 507-13
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-2634
Mailing Address - Country:US
Mailing Address - Phone:727-201-2163
Mailing Address - Fax:727-290-4156
Practice Address - Street 1:2708 ALT 19 STE 507-13
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-2634
Practice Address - Country:US
Practice Address - Phone:727-201-2163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-08
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10128101YP2500X
FLMH9649101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH9649OtherSTATE OF FLORIDA LICENSE NUMBER
NC10128OtherNCBLPC