Provider Demographics
NPI:1922255645
Name:JOHNSON, VERONICA IDA (LCPC)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:IDA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9250 SHARPTAIL DR
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-1002
Mailing Address - Country:US
Mailing Address - Phone:406-240-6543
Mailing Address - Fax:
Practice Address - Street 1:9250 SHARPTAIL DR
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1002
Practice Address - Country:US
Practice Address - Phone:406-240-6543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-25
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1344101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional