Provider Demographics
NPI:1689180598
Name:JOHNSON COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:JOHNSON COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER, THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:319-382-4721
Mailing Address - Street 1:700 16TH ST NE STE 205
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-4665
Mailing Address - Country:US
Mailing Address - Phone:319-382-4721
Mailing Address - Fax:319-320-1211
Practice Address - Street 1:700 16TH ST NE STE 205
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-4665
Practice Address - Country:US
Practice Address - Phone:319-382-4721
Practice Address - Fax:319-320-1211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-15
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0749461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1538688213Medicaid