Healthcare Provider Details

I. General information

NPI: 1518820703
Provider Name (Legal Business Name): J.R. JOHNSON COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16601 N 40TH ST STE 216
PHOENIX AZ
85032-3354
US

IV. Provider business mailing address

4166 W EVANS DR
PHOENIX AZ
85053-5326
US

V. Phone/Fax

Practice location:
  • Phone: 480-299-6564
  • Fax:
Mailing address:
  • Phone: 480-299-6564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: JACOB RYNE JOHNSON
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: LPC
Phone: 480-299-6564