Provider Demographics
NPI:1821739095
Name:JOHANNSEN, TEDDI (SWLC, LAC)
Entity Type:Individual
Prefix:
First Name:TEDDI
Middle Name:
Last Name:JOHANNSEN
Suffix:
Gender:F
Credentials:SWLC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 DILLON RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59912-8928
Mailing Address - Country:US
Mailing Address - Phone:406-212-2269
Mailing Address - Fax:
Practice Address - Street 1:144 2ND ST W
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-3074
Practice Address - Country:US
Practice Address - Phone:406-298-5728
Practice Address - Fax:406-730-2488
Is Sole Proprietor?:No
Enumeration Date:2022-04-04
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LAC-LIC-59080101YA0400X
MTBBH-SWLC-LIC-550431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)