Provider Demographics
NPI:1184761892
Name:JOHNSON, THOMAS HENRY (PHD LPCC)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:HENRY
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PHD LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11217 KENWORTH LN
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-8426
Mailing Address - Country:US
Mailing Address - Phone:952-435-7483
Mailing Address - Fax:
Practice Address - Street 1:7101 YORK AVE S STE 335
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4428
Practice Address - Country:US
Practice Address - Phone:612-239-5473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health