=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497992440
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ASHLEY DANELLE JOHNSON LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2009
-----------------------------------------------------
Last Update Date | 02/27/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 624 HOSPITAL DR 6 SOUTH
-----------------------------------------------------
City | MOUNTAIN HOME
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72653-2955
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-508-7820
-----------------------------------------------------
Fax | 870-508-7614
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 958539
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63195-8539
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-508-7610
-----------------------------------------------------
Fax | 870-508-7614
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 3726-C
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------