Healthcare Provider Details

I. General information

NPI: 1164011466
Provider Name (Legal Business Name): JILLIAN M JOHNSON LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JILLIAN M YOUNG LPC

II. Dates (important events)

Enumeration Date: 01/12/2021
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4771 WASHINGTON AVE
RAVENNA OH
44266-9631
US

IV. Provider business mailing address

527 N MERIDIAN RD
YOUNGSTOWN OH
44509-1227
US

V. Phone/Fax

Practice location:
  • Phone: 330-399-6451
  • Fax:
Mailing address:
  • Phone: 330-797-0070
  • Fax: 330-797-9146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2505120
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.2103077
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: