Provider Demographics
NPI:1932877586
Name:JOHNSON, MAGDA LORAYNE (MA,LMHC)
Entity Type:Individual
Prefix:
First Name:MAGDA
Middle Name:LORAYNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA,LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 LA VISTA
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505
Mailing Address - Country:US
Mailing Address - Phone:715-851-5653
Mailing Address - Fax:
Practice Address - Street 1:4001 OFFICE COURT DR STE 701
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-4905
Practice Address - Country:US
Practice Address - Phone:505-207-8929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCMH0219091101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health