Healthcare Provider Details
I. General information
NPI: 1306410246
Provider Name (Legal Business Name): SANTRESDA JOHNSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 05/15/2021
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:
III. Provider practice location address
725 KINGSLAND AVE STE 100
SAINT LOUIS MO
63130-3187
US
IV. Provider business mailing address
725 KINGSLAND AVE STE 100
SAINT LOUIS MO
63130-3187
US
V. Phone/Fax
- Phone: 907-444-3928
- Fax:
- Phone: 907-444-3928
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101Y00000X |
| Taxonomy | Counselor |
| License Number | 7081005 |
| License Number State | ID |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101Y00000X |
| Taxonomy | Counselor |
| License Number | LPCCANIDIDATE13178 |
| License Number State | OK |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101Y00000X |
| Taxonomy | Counselor |
| License Number | E.2606655 |
| License Number State | OH |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101YM0800X |
| Taxonomy | Mental Health Counselor |
| License Number | 2025031718 |
| License Number State | MO |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101YM0800X |
| Taxonomy | Mental Health Counselor |
| License Number | 7081005 |
| License Number State | ID |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101YM0800X |
| Taxonomy | Mental Health Counselor |
| License Number | E.2606655 |
| License Number State | OH |
| # 7 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 101YM0800X |
| Taxonomy | Mental Health Counselor |
| License Number | 217581 |
| License Number State | AK |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101YM0800X |
| Taxonomy | Mental Health Counselor |
| License Number | LPCCANIDIDATE13178 |
| License Number State | OK |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101YP2500X |
| Taxonomy | Professional Counselor |
| License Number | 2025031718 |
| License Number State | MO |
| # 10 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103K00000X |
| Taxonomy | Behavior Analyst |
| License Number | |
| License Number State | NULL |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103K00000X |
| Taxonomy | Behavior Analyst |
| License Number | 217581 |
| License Number State | AK |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
