Provider Demographics
NPI:1619530540
Name:JOHNSON, KARL WILLIAM II (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:KARL
Middle Name:WILLIAM
Last Name:JOHNSON
Suffix:II
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7251 SUNDALE DR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49548-7345
Mailing Address - Country:US
Mailing Address - Phone:616-893-7345
Mailing Address - Fax:
Practice Address - Street 1:7251 SUNDALE DR SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49548-7345
Practice Address - Country:US
Practice Address - Phone:616-893-7345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-16
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401019152101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional