Healthcare Provider Details

I. General information

NPI: 1831021286
Provider Name (Legal Business Name): JOSEPH MITCHELL JOHNSON SWLC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 N 22ND AVE STE 1
BOZEMAN MT
59718-3153
US

IV. Provider business mailing address

819 W KOCH ST
BOZEMAN MT
59715-4434
US

V. Phone/Fax

Practice location:
  • Phone: 406-579-4984
  • Fax:
Mailing address:
  • Phone: 406-451-5775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberBBH-SWLC-LIC-81244
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: