Provider Demographics
NPI:1619399532
Name:JOHNSON, ELLEN M (LMFT)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 104
Mailing Address - Street 2:
Mailing Address - City:FALLON
Mailing Address - State:NV
Mailing Address - Zip Code:89407-0104
Mailing Address - Country:US
Mailing Address - Phone:775-432-7995
Mailing Address - Fax:775-420-4408
Practice Address - Street 1:40 E CENTER ST STE 12
Practice Address - Street 2:
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89406-3474
Practice Address - Country:US
Practice Address - Phone:775-432-7995
Practice Address - Fax:775-420-4408
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-12
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV00530-LC101YA0400X
NV2589106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV00530-LCOtherSTATE OF NV BOARD OF EXAMINERS FOR ALCOHOL, DRUG AND GAMBLING COUNSELORS
NV2589OtherSTATE OF NEVADA BOARD OF EXAMINERS FOR MARRIAGE AND FAMILY THERAPISTS & CPC