Provider Demographics
NPI:1831679422
Name:JOHNSON, MEGAN (LPCC)
Entity type:Individual
Prefix:
First Name:MEGAN
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 1:105 2ND AVE NE STE 110
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:56334-1226
Mailing Address - Country:US
Mailing Address - Phone:320-428-0744
Mailing Address - Fax:320-438-2829
Practice Address - Street 1:10 E 6TH ST STE 102
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:MN
Practice Address - Zip Code:56267-1362
Practice Address - Country:US
Practice Address - Phone:320-428-0744
Practice Address - Fax:320-438-2829
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3479101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional