Provider Demographics
NPI:1649329376
Name:JOHNSON, LOUISE MARIE (LPCC/S)
Entity type:Individual
Prefix:MRS
First Name:LOUISE
Middle Name:MARIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPCC/S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2463 E COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45502-9527
Mailing Address - Country:US
Mailing Address - Phone:937-631-0043
Mailing Address - Fax:
Practice Address - Street 1:2463 E COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45502-9527
Practice Address - Country:US
Practice Address - Phone:937-631-0043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0007767101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health