Provider Demographics
NPI:1255576609
Name:JOHNSON, JOHN ROBERT (LPCC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ROBERT
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 NODAK DR S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-2333
Mailing Address - Country:US
Mailing Address - Phone:701-232-6224
Mailing Address - Fax:
Practice Address - Street 1:1920 COLLEGE WAY
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-1060
Practice Address - Country:US
Practice Address - Phone:701-232-6224
Practice Address - Fax:701-232-4687
Is Sole Proprietor?:No
Enumeration Date:2008-12-12
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN19101YP2500X
MNCC00019101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional