Healthcare Provider Details

I. General information

NPI: 1336187194
Provider Name (Legal Business Name): DANNY S JOHNSON MA, LCSW, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 01/07/2020
Certification Date: 01/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2751 THOMAS DR STE 102
CAPE GIRARDEAU MO
63701-2131
US

IV. Provider business mailing address

1952 PERRYVILLE RD
CAPE GIRARDEAU MO
63701-2425
US

V. Phone/Fax

Practice location:
  • Phone: 573-334-3486
  • Fax: 573-334-3524
Mailing address:
  • Phone: 573-335-1438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number001716
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number000976
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: