Provider Demographics
NPI:1902204894
Name:JOHNSON, DELAIN KAY (MS-LPC, NCC)
Entity Type:Individual
Prefix:
First Name:DELAIN
Middle Name:KAY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS-LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 CENTRE ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57703-3002
Mailing Address - Country:US
Mailing Address - Phone:605-347-0422
Mailing Address - Fax:605-347-0422
Practice Address - Street 1:1501 CENTRE ST
Practice Address - Street 2:SUITE 106
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57703-3002
Practice Address - Country:US
Practice Address - Phone:605-347-0422
Practice Address - Fax:605-347-0422
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-09
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD7286101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health