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General NPI Number Information
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NPI Number | 1427715838
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Entity Type | Individual
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Provider Name | MAXINE JOHNSON MA. LPCC
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Gender | Female
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Dates
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Enumeration Date | 11/19/2021
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 1100 GLENWOOD AVE
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City | MINNEAPOLIS
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State | MN
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Zip | 55405-1430
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Country | US
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Telephone | 612-871-1454
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Fax |
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Provider Business Mailing Address
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Address Line | 8641 QUEEN AVE S
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City | BLOOMINGTON
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State | MN
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Zip | 55431-1903
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Country | US
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Telephone |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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