Healthcare Provider Details

I. General information

NPI: 1548094105
Provider Name (Legal Business Name): NATALIE JOHNSON LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2024
Last Update Date: 08/27/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7701 YORK AVE S, STE 350
EDINA MN
55435
US

IV. Provider business mailing address

7701 YORK AVE S, STE 350
EDINA MN
55435
US

V. Phone/Fax

Practice location:
  • Phone: 952-926-2526
  • Fax: 952-926-6791
Mailing address:
  • Phone: 952-926-2526
  • Fax: 952-926-6791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCC-04536
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: