=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225848724
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GENEVIEVE JOHNSON PSYCHOTHERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2025
-----------------------------------------------------
Last Update Date | 01/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2130 MOUNTAIN VIEW AVE STE 202
-----------------------------------------------------
City | LONGMONT
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80501-3177
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-600-4992
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1124 KANSAS AVE
-----------------------------------------------------
City | LONGMONT
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80501-6648
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-215-9128
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | GENEVIEVE JOHNSON
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 916-215-9128
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------