Provider Demographics
NPI:1780012443
Name:JOHNSON, AMY (LPCC)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 6 BOX 5
Mailing Address - Street 2:
Mailing Address - City:STILWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74960-9501
Mailing Address - Country:US
Mailing Address - Phone:918-797-7786
Mailing Address - Fax:
Practice Address - Street 1:821 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-3526
Practice Address - Country:US
Practice Address - Phone:479-427-6216
Practice Address - Fax:479-427-6216
Is Sole Proprietor?:No
Enumeration Date:2013-10-16
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program