Healthcare Provider Details

I. General information

NPI: 1164642294
Provider Name (Legal Business Name): DENISE JOHNSON LSW, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4720 GUILFORD AVE
INDIANAPOLIS IN
46205-1956
US

IV. Provider business mailing address

4720 GUILFORD AVE
INDIANAPOLIS IN
46205-1956
US

V. Phone/Fax

Practice location:
  • Phone: 317-283-3270
  • Fax: 317-283-2685
Mailing address:
  • Phone: 317-283-3270
  • Fax: 317-283-2685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39000912A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number39000912A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number39000912A
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number33003101A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: