MEDICARE: ALYSSA JOHNSON LPC

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
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1407379704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA JOHNSON LPC

Provider Business Mailing Address
First Line	:	631 N FOOTE AVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-4503
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7750 N UNION BLVD STE 202
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-4082
Country	:	US
Telephone Number	:	719-357-8957
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2017
Last Update Date	:	07/28/2017

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Directions to “ ALYSSA JOHNSON LPC” Practice Location

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