Provider Demographics
NPI:1770373706
Name:JOHNSON, DIANA (LAMFT)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1088 JUNO AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-1739
Mailing Address - Country:US
Mailing Address - Phone:161-222-7462
Mailing Address - Fax:
Practice Address - Street 1:101 W BURNSVILLE PKWY STE 208
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-4401
Practice Address - Country:US
Practice Address - Phone:651-314-3815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4710106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist