Healthcare Provider Details

I. General information

NPI: 1467169086
Provider Name (Legal Business Name): MITCHELL JOHNSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2022
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2253 75TH AVE
GREELEY CO
80634-7406
US

IV. Provider business mailing address

5720 BIG CANYON DR
FORT COLLINS CO
80528-6905
US

V. Phone/Fax

Practice location:
  • Phone: 970-400-7370
  • Fax:
Mailing address:
  • Phone: 303-514-6665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberLPC.0019148
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC-926
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0019148
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: