Provider Demographics
NPI:1821782608
Name:JOHNSON, GRADY STEPHEN (LMFT)
Entity Type:Individual
Prefix:MR
First Name:GRADY
Middle Name:STEPHEN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1046 PALOMINO PL
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-6911
Mailing Address - Country:US
Mailing Address - Phone:406-217-7795
Mailing Address - Fax:
Practice Address - Street 1:12 AVANTA WAY STE 2
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-6921
Practice Address - Country:US
Practice Address - Phone:406-272-6228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-06
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LMFT-LIC-64301106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist