Healthcare Provider Details

I. General information

NPI: 1689681116
Provider Name (Legal Business Name): BARBARA L JOHNSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 BOGLE ST STE A
SOMERSET KY
42503-2815
US

IV. Provider business mailing address

PO BOX 1080
BURKESVILLE KY
42717-1080
US

V. Phone/Fax

Practice location:
  • Phone: 606-677-0201
  • Fax: 606-677-0208
Mailing address:
  • Phone: 270-858-6655
  • Fax: 270-858-4607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1172
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: