Provider Demographics
NPI:1629476999
Name:JOHNSON, LARA (PLMHP)
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-1784
Mailing Address - Country:US
Mailing Address - Phone:402-880-2799
Mailing Address - Fax:
Practice Address - Street 1:1402 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-1784
Practice Address - Country:US
Practice Address - Phone:402-880-2799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-18
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11904101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor