Provider Demographics
NPI:1245214154
Name:JOHNSEN, ALLISON G (MA, LCPC)
Entity type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:G
Last Name:JOHNSEN
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:G
Other - Last Name:PARKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LCPC
Mailing Address - Street 1:41W161 WHITNEY RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-8571
Mailing Address - Country:US
Mailing Address - Phone:630-222-6177
Mailing Address - Fax:
Practice Address - Street 1:2445 DEAN ST UNIT A
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-4828
Practice Address - Country:US
Practice Address - Phone:630-222-6177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2019-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-005892101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL22-3861676OtherTAX ID NUMBER FOR PRACTIC