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General NPI Number Information
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NPI Number | 1013586395
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Entity Type | Individual
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Provider Name | COURTNEY S. JOHNSON LPC
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Gender | Female
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Dates
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Enumeration Date | 06/22/2021
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Last Update Date | 10/27/2024
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Provider Practice Location Address
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Address Line | 1047 S WELLS ST
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City | MERIDIAN
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State | ID
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Zip | 83642-7997
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Country | US
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Telephone | 208-670-5551
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Fax |
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Provider Business Mailing Address
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Address Line | 702 SUNSET DR
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City | ONTARIO
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State | OR
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Zip | 97914-3121
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Country | US
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Telephone | 541-889-9167
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Fax | 541-889-7873
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC-8187
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License Number State | ID
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