Provider Demographics
NPI:1891075248
Name:JOHNSON, ROBERT FREDRICK (MED, LMHC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:FREDRICK
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MED, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 E MCLOUGHLIN BLVD.
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663
Mailing Address - Country:US
Mailing Address - Phone:360-281-6824
Mailing Address - Fax:360-314-2908
Practice Address - Street 1:601 E MCLOUGHLIN BLVD.
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663
Practice Address - Country:US
Practice Address - Phone:360-281-6824
Practice Address - Fax:360-314-2908
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-17
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00005991101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health