Healthcare Provider Details

I. General information

NPI: 1609341593
Provider Name (Legal Business Name): LINDY ANNE JOHNSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2018
Last Update Date: 11/11/2023
Certification Date: 11/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 E OHIO ST STE 11
CLINTON MO
64735-2362
US

IV. Provider business mailing address

PO BOX 387
CLINTON MO
64735-0387
US

V. Phone/Fax

Practice location:
  • Phone: 816-507-6451
  • Fax:
Mailing address:
  • Phone: 816-507-6451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2018036138
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: