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General NPI Number Information
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NPI Number | 1396228516
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Entity Type | Individual
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Provider Name | JENNY LYNN JOHNSON MA, LPC, LAC
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Gender | Female
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Dates
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Enumeration Date | 09/13/2018
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Last Update Date | 12/20/2023
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Provider Practice Location Address
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Address Line | 801 N WEBER ST STE 103
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City | COLORADO SPRINGS
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State | CO
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Zip | 80903-5927
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Country | US
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Telephone | 719-345-7095
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Fax |
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Provider Business Mailing Address
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Address Line | 2057 BROOKWOOD DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80918-1135
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Country | US
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Telephone | 719-290-8860
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | ACB.0008305
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | ACD.0001918
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC.0017586
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License Number State | CO
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