Provider Demographics
NPI:1942492400
Name:JOHNSON, STACY (MS, LCPC, RPT-S)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS, LCPC, RPT-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 MASSACHUSETTS ST STE 128
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-2345
Mailing Address - Country:US
Mailing Address - Phone:785-657-4099
Mailing Address - Fax:785-856-6006
Practice Address - Street 1:719 MASSACHUSETTS ST STE 128
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-2345
Practice Address - Country:US
Practice Address - Phone:785-657-4099
Practice Address - Fax:785-856-6006
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2019-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLCPC 727101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional