Provider Demographics
NPI:1891094371
Name:JOHNSON, JILL MARIE (LMHC, LMHP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:MARIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMHC, LMHP
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:MARIE
Other - Last Name:CARLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:515 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-4419
Mailing Address - Country:US
Mailing Address - Phone:712-322-1407
Mailing Address - Fax:
Practice Address - Street 1:515 E BROADWAY
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-4419
Practice Address - Country:US
Practice Address - Phone:712-322-1407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-23
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA075889101YM0800X
NE4333101YM0800X
NE2108101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional