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General NPI Number Information
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NPI Number | 1346510740
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Entity Type | Organization
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Legal Business Name | LISA J JOHNSON LMFT LLC
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Dates
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Enumeration Date | 01/03/2012
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Last Update Date | 01/03/2012
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Provider Practice Location Address
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Address Line | 3214 PURDUE PL NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-2124
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Country | US
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Telephone | 505-288-2162
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Fax | 505-266-1440
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Provider Business Mailing Address
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Address Line | 817 CARLISLE BLVD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-1209
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Country | US
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Telephone | 505-288-2162
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Fax | 505-266-1440
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | MS. LISA J JOHNSON
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Credential | LMFT
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Telephone | 505-288-2162
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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 |
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License Number State |
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