MEDICARE: ELIZABETH (BETSY) JANE JOHNSON 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
1	101YM0800X	Mental Health Counselor	LCPC-5420	ID

General Provider Information

NPI Number	:	1568769164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH (BETSY) JANE JOHNSON LCPC

Provider Business Mailing Address
First Line	:	9503 W SAGEBERRY DR
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83709-5104
Country	:	US
Telephone Number	:	208-407-0688
Fax Number	:

Provider Business Practice Location Address
First Line	:	9503 W SAGEBERRY DR
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83709-5104
Country	:	US
Telephone Number	:	208-407-0688
Fax Number	:

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

Provider Enumeration Date	:	02/16/2011
Last Update Date	:	03/05/2026

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