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General NPI Number Information
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NPI Number | 1316077696
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Entity Type | Individual
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Provider Name | CAROL S JOHNSON LMFT
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Gender | Female
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 02/03/2023
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Provider Practice Location Address
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Address Line | 630 HAINES AVE NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87102-1226
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Country | US
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Telephone | 505-268-5611
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Fax |
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Provider Business Mailing Address
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Address Line | 5 LANE LN
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City | SHERIDAN
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State | WY
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Zip | 82801-8630
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Country | US
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Telephone | 307-675-4120
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 578
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 310445
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 203
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License Number State | WY
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