Provider Demographics
NPI:1659836088
Name:JOHNSON, MARGARET KEELEY (LPC-MHSP)
Entity Type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:KEELEY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:MS
Other - First Name:MARGARET
Other - Middle Name:KEELEY
Other - Last Name:BENNETT-JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:7311 CLINTON HWY STE B
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37849-5224
Mailing Address - Country:US
Mailing Address - Phone:865-507-3636
Mailing Address - Fax:
Practice Address - Street 1:7311 CLINTON HWY STE B
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849-5224
Practice Address - Country:US
Practice Address - Phone:865-507-3636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-11
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.16307101YP2500X
TN4118101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ051173Medicaid
TNQ051173Medicaid