=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528742186
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NICOLE JOHNSON LMHC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2023
-----------------------------------------------------
Last Update Date | 03/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3606 KIMBALL AVE STE 13
-----------------------------------------------------
City | WATERLOO
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50702-5731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-242-6140
-----------------------------------------------------
Fax | 319-242-6141
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2726 ARBOR RIDGE RD
-----------------------------------------------------
City | CEDAR FALLS
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50613-2379
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-242-6140
-----------------------------------------------------
Fax | 319-242-6141
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 094548
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------