Healthcare Provider Details

I. General information

NPI: 1710024971
Provider Name (Legal Business Name): TRACEY L JOHNSON LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4250 MARTIN WAY E STE 105
OLYMPIA WA
98516-5317
US

IV. Provider business mailing address

4250 MARTIN WAY E STE 105
OLYMPIA WA
98516-5317
US

V. Phone/Fax

Practice location:
  • Phone: 360-790-3006
  • Fax:
Mailing address:
  • Phone: 360-790-3006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH00007436
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: