| Doctor Name: | MR. JOHN ROBERT JOHNSON |
| NPI Number: | 1255576609 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | L.P.C.C. |
| License Number: | CC00019 |
| Business Practice Address: | 13021 Evergreen Dr Baxter, MN - 564257439 |
| Business Phone Number: | 2188299307 |
| Business Fax Number: | 2188297649 |
| Mailing Address: | 1900 Silver Lake Rd Nw, Suite 110 NEW BRIGHTON |
| State: | MN |
| Postal Code: | 551121786 |
| Phone Number: | 6513791718 |
| Fax Number: | 6513791738 |
| NPI Enumeration Date: | 12/12/2008 |
| NPI Last Update Date: | 07/15/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | CC00019 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |