Provider Demographics
NPI:1790458248
Name:JOHNSON, AMY L (CSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 E SOUTH TEMPLE STE 103
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-1323
Mailing Address - Country:US
Mailing Address - Phone:385-218-8266
Mailing Address - Fax:801-364-1433
Practice Address - Street 1:KATHLEEN LAKEY AND ASSOCIATES
Practice Address - Street 2:275 EAST SOUTH TEMPLE, STE 103
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111
Practice Address - Country:US
Practice Address - Phone:385-218-8266
Practice Address - Fax:801-364-1433
Is Sole Proprietor?:No
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT123100283502101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health