Doctor Name: | JORDAN LEE JOHNSON |
NPI Number: | 1023346012 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MA, LPC, LPCC |
License Number: | 4851-125 |
Business Practice Address: | 6303 Osgood Ave N Stillwater, MN - 550826101 |
Business Phone Number: | 6513834800 |
Business Fax Number: | 6513834801 |
Mailing Address: | 6303 Osgood Ave N, STILLWATER |
State: | MN |
Postal Code: | 550826101 |
Phone Number: | 6513834800 |
Fax Number: | 6513834801 |
NPI Enumeration Date: | 12/02/2009 |
NPI Last Update Date: | 10/03/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 4851-125 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | WI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |