Healthcare Provider Details

I. General information

NPI: 1063820249
Provider Name (Legal Business Name): JAMIE LEE JOHNSON M.S., ED, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2014
Last Update Date: 12/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2980 BELMONT AVE
YOUNGSTOWN OH
44505-1834
US

IV. Provider business mailing address

2980 BELMONT AVE
YOUNGSTOWN OH
44505-1834
US

V. Phone/Fax

Practice location:
  • Phone: 330-759-2310
  • Fax: 330-759-0018
Mailing address:
  • Phone: 330-759-2310
  • Fax: 330-759-0018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.1000558
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: