Provider Demographics
NPI:1336187194
Name:JOHNSON, DANNY S (MA, LCSW, LPC)
Entity Type:Individual
Prefix:MR
First Name:DANNY
Middle Name:S
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MA, LCSW, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1952 PERRYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-2425
Mailing Address - Country:US
Mailing Address - Phone:573-335-1438
Mailing Address - Fax:
Practice Address - Street 1:2751 THOMAS DR STE 102
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-2131
Practice Address - Country:US
Practice Address - Phone:573-334-3486
Practice Address - Fax:573-334-3524
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0009761041C0700X
MO001716101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
431823864OtherVALUE OPTIONS
433166OtherEPOCH
6223868OtherUNITED HELATH CARE
431823864OtherWELL POINT
433166OtherCENTURY PLANNERS
431823864OtherMO ALLIANCE
433166OtherHEALTHLINK FREEDOM
433166OtherFIRST ADMINISTRATION
433166OtherHEALTHLINK/PPO
237961OtherCOMPPSYCH
431823864OtherGREAT WEST
433166OtherFIRST HEALTH
431823864OtherCORP HEALTH
431823864OtherMAGELLAN
433166OtherFORTIS/HL
148597OtherBLUE CROSS BLUE SHIELD
433166OtherENCOMPASS
MO493267124Medicaid
431823864OtherMULTIPLAN
433166OtherHEALTHLINK/PPO
433166OtherEPOCH
MO990001748Medicare PIN