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General NPI Number Information
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NPI Number | 1265892517
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Entity Type | Individual
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Provider Name | KIT JOHNSON LADC, CDGC, LIMHP
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Gender | Male
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Dates
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Enumeration Date | 02/29/2016
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Last Update Date | 04/23/2022
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Provider Practice Location Address
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Address Line | 2222 2ND AVE # 16 SUITE 400
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City | KEARNEY
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State | NE
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Zip | 68847-5354
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Country | US
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Telephone | 308-234-2119
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Fax | 308-234-2122
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Provider Business Mailing Address
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Address Line | 2222 2ND AVE # 16 SUITE 400
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City | KEARNEY
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State | NE
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Zip | 68847-5354
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Country | US
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Telephone | 308-234-2119
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Fax | 308-234-2122
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 921
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2461
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License Number State | NE
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