Provider Demographics
NPI:1689102204
Name:JOHNSON COUNSELING LLC
Entity Type:Organization
Organization Name:JOHNSON COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:270-784-0724
Mailing Address - Street 1:996 WILKINSON TRCE STE A9
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-3408
Mailing Address - Country:US
Mailing Address - Phone:270-784-0724
Mailing Address - Fax:270-904-1073
Practice Address - Street 1:996 WILKINSON TRCE STE A9
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-3408
Practice Address - Country:US
Practice Address - Phone:270-784-0724
Practice Address - Fax:270-904-1073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2521861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty