Healthcare Provider Details

I. General information

NPI: 1134285802
Provider Name (Legal Business Name): GILBERT J JOHNSON LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 01/05/2021
Certification Date: 01/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12715 E MISSION AVE
SPOKANE VALLEY WA
99216-1027
US

IV. Provider business mailing address

PO BOX 48711
SPOKANE WA
99228-1711
US

V. Phone/Fax

Practice location:
  • Phone: 509-232-5766
  • Fax:
Mailing address:
  • Phone: 509-389-1414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH00004881
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: