Provider Demographics
NPI:1265229215
Name:TRICIA JOHNSON WELLNESS, PLLC
Entity type:Organization
Organization Name:TRICIA JOHNSON WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:847-916-0034
Mailing Address - Street 1:1524 JULIET LN
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-4426
Mailing Address - Country:US
Mailing Address - Phone:847-922-2029
Mailing Address - Fax:
Practice Address - Street 1:1870 W. WINCHESTER R.
Practice Address - Street 2:STE 148
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-4426
Practice Address - Country:US
Practice Address - Phone:847-916-0034
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health