Healthcare Provider Details

I. General information

NPI: 1023932449
Provider Name (Legal Business Name): SARAH JEAN JOHNSON LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19045 ELIZABETH CT
SPRING LAKE MI
49456-9662
US

IV. Provider business mailing address

19045 ELIZABETH CT
SPRING LAKE MI
49456-9662
US

V. Phone/Fax

Practice location:
  • Phone: 616-625-9992
  • Fax:
Mailing address:
  • Phone: 616-625-9992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451025248
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: