Provider Demographics
NPI:1396959219
Name:JOHNSON, KARIN CHANDLER (LPC)
Entity type:Individual
Prefix:
First Name:KARIN
Middle Name:CHANDLER
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4770 BASELINE RD
Mailing Address - Street 2:STE 310
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-2666
Mailing Address - Country:US
Mailing Address - Phone:303-902-6320
Mailing Address - Fax:720-304-0114
Practice Address - Street 1:4770 BASELINE RD
Practice Address - Street 2:STE 310
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-2666
Practice Address - Country:US
Practice Address - Phone:303-902-6320
Practice Address - Fax:720-304-0114
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3343101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health