Provider Demographics
NPI:1780999102
Name:JOHNSON, RENEE L (MS, LMHP, LPC, NCC)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS, LMHP, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11919 GRANT ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-3475
Mailing Address - Country:US
Mailing Address - Phone:402-312-0053
Mailing Address - Fax:402-504-4584
Practice Address - Street 1:11919 GRANT ST
Practice Address - Street 2:SUITE 201
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-3475
Practice Address - Country:US
Practice Address - Phone:402-312-0053
Practice Address - Fax:402-504-4584
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4137101YM0800X
NE2032101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE470785436Medicaid