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NPI Code Detail

MEDICARE: JEFF T JOHNSON LPC, LCPC

MEDICARE: JEFF T JOHNSON LPC, LCPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorLCPC-8059ID
2101YM0800XMental Health CounselorBBH-LCPC-LIC-49328MT
3101YM0800XMental Health CounselorPC5834ME
4101YM0800XMental Health CounselorC5747OR
5101YM0800XMental Health CounselorCO.0012791CO

General Provider Information

NPI Number : 1083383673
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFF T JOHNSON LPC, LCPC
Provider Business Mailing Address
First Line : 233 E MAIN ST STE 401
Second Line :
City : BOZEMAN
State : MT
Zip : 59715-5045
Country : US
Telephone Number : 720-212-8508
Fax Number :
Provider Business Practice Location Address
First Line : 233 E MAIN ST STE 401
Second Line :
City : BOZEMAN
State : MT
Zip : 59715-5045
Country : US
Telephone Number : 720-212-8508
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/08/2021
Last Update Date : 03/24/2024

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