Provider Demographics
NPI:1841061421
Name:JOHNSON, ABBY LEIGH (LPC, LMHC, ATR)
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:LEIGH
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPC, LMHC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 87
Mailing Address - Street 2:
Mailing Address - City:OJO CALIENTE
Mailing Address - State:NM
Mailing Address - Zip Code:87549-0087
Mailing Address - Country:US
Mailing Address - Phone:505-230-8291
Mailing Address - Fax:
Practice Address - Street 1:NORTHSTAR PLAZA, 65 STATE HWY 522, UNIT 65B1
Practice Address - Street 2:
Practice Address - City:EL PRADO
Practice Address - State:NM
Practice Address - Zip Code:87529
Practice Address - Country:US
Practice Address - Phone:505-230-8291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCMH0223951101YM0800X
COLPC.0020193101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health