Provider Demographics
NPI:1932194800
Name:JOHNSON, ERIC R (MS)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:R
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 PUGET ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-2148
Mailing Address - Country:US
Mailing Address - Phone:360-770-8487
Mailing Address - Fax:360-336-3315
Practice Address - Street 1:1330A S 2ND ST
Practice Address - Street 2:SUITE 102
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-4804
Practice Address - Country:US
Practice Address - Phone:360-770-8487
Practice Address - Fax:360-336-3315
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00003649101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health