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General NPI Number Information
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NPI Number | 1184180655
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Entity Type | Individual
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Provider Name | JACOB RYNE JOHNSON COUNSELOR, PROF
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Gender | Male
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Dates
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Enumeration Date | 02/20/2019
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 16601 N 40TH ST STE 216
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City | PHOENIX
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State | AZ
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Zip | 85032-3354
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Country | US
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Telephone | 623-469-0606
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Fax |
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Provider Business Mailing Address
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Address Line | 16601 N 40TH ST STE 216
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City | PHOENIX
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State | AZ
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Zip | 85032-3354
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Country | US
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Telephone | 623-469-0606
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Fax |
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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-17622
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LPC-17622
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License Number State | AZ
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