Provider Demographics
NPI:1700400223
Name:JOHNSON, AVA (PLPC)
Entity Type:Individual
Prefix:
First Name:AVA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N WASHINGTON ST STE 229
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-1716
Mailing Address - Country:US
Mailing Address - Phone:573-218-9653
Mailing Address - Fax:573-803-1405
Practice Address - Street 1:400 N WASHINGTON ST STE 229
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-1716
Practice Address - Country:US
Practice Address - Phone:573-218-9653
Practice Address - Fax:573-803-1405
Is Sole Proprietor?:No
Enumeration Date:2020-06-01
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional