| Doctor Name: | MARCY J JOHNSON |
| NPI Number: | 1700139441 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LSW |
| License Number: | ACC-7168 |
| Business Practice Address: | 1950 Redtail Hawk Dr Estes Park, CO - 805179780 |
| Business Phone Number: | 9705869105 |
| Business Fax Number: | 9703469800 |
| Mailing Address: | 125 Crestridge St, FORT COLLINS |
| State: | CO |
| Postal Code: | 805253934 |
| Phone Number: | 9704949761 |
| Fax Number: | 9703469800 |
| NPI Enumeration Date: | 10/18/2012 |
| NPI Last Update Date: | 10/18/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | ACC-7168 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |