Provider Demographics
NPI:1942540786
Name:JOHNSON, JONATHEN ROBERT (LCPC)
Entity Type:Individual
Prefix:MR
First Name:JONATHEN
Middle Name:ROBERT
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 REDROCK DR
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89048-6418
Mailing Address - Country:US
Mailing Address - Phone:702-497-7639
Mailing Address - Fax:
Practice Address - Street 1:2965 S JONES BLVD STE C-1
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5629
Practice Address - Country:US
Practice Address - Phone:702-471-0420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-14
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCP2955101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health