Healthcare Provider Details

I. General information

NPI: 1518492784
Provider Name (Legal Business Name): KYLE ANN JOHNSON LCPC, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KYLE ANN LUCAS

II. Dates (important events)

Enumeration Date: 04/25/2017
Last Update Date: 04/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 S EWING ST STE 511
HELENA MT
59601-5732
US

IV. Provider business mailing address

560 RAVEN RUN APT 1
HELENA MT
59601-8524
US

V. Phone/Fax

Practice location:
  • Phone: 406-996-1034
  • Fax:
Mailing address:
  • Phone: 406-579-5039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLAC-LIC-3436
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37585
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: