Healthcare Provider Details

I. General information

NPI: 1528585874
Provider Name (Legal Business Name): SARAH MARIE JOHNSON LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2017
Last Update Date: 02/08/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 N AMES ST STE 2
SPEARFISH SD
57783-1975
US

IV. Provider business mailing address

689 SOUTH ST
WHITEWOOD SD
57793-6001
US

V. Phone/Fax

Practice location:
  • Phone: 605-412-8600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT11540
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: