Healthcare Provider Details

I. General information

NPI: 1275953150
Provider Name (Legal Business Name): MARILEE JOHNSON-GEARY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2014
Last Update Date: 12/27/2022
Certification Date: 12/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E HAVENS AVE STE 100
MITCHELL SD
57301-4461
US

IV. Provider business mailing address

1321 E 2ND AVE
MITCHELL SD
57301-3733
US

V. Phone/Fax

Practice location:
  • Phone: 605-999-6162
  • Fax: 605-942-7300
Mailing address:
  • Phone: 605-999-6162
  • Fax: 605-942-7300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC-MH2111
License Number StateSD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MS. MARILEE KAY JOHNSON-GEARY
Title or Position: MENTAL HEALTH & ADDICTION COUNSELOR
Credential: LPC-MH, QMHP, LAC
Phone: 605-201-1191