Provider Demographics
NPI:1922626456
Name:TESS R JOHNSON, PLLC
Entity Type:Organization
Organization Name:TESS R JOHNSON, PLLC
Other - Org Name:PIVOTAL COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER OF PRIVATE PRACTICE/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TESS
Authorized Official - Middle Name:R
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:701-521-0503
Mailing Address - Street 1:579 RIVER DRIVE
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601
Mailing Address - Country:US
Mailing Address - Phone:701-521-0503
Mailing Address - Fax:
Practice Address - Street 1:25 1ST AVE W STE 160
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-5157
Practice Address - Country:US
Practice Address - Phone:701-787-1100
Practice Address - Fax:701-787-1600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-10
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty