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General NPI Number Information
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NPI Number | 1568769164
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Entity Type | Individual
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Provider Name | ELIZABETH (BETSY) JANE JOHNSON LCPC
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Gender | Female
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Dates
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Enumeration Date | 02/16/2011
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Last Update Date | 04/22/2020
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Provider Practice Location Address
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Address Line | 6126 W STATE ST SUITE 201
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City | BOISE
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State | ID
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Zip | 83703-2741
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Country | US
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Telephone | 208-407-0688
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Fax | 208-391-5550
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Provider Business Mailing Address
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Address Line | 9503 W SAGEBERRY DR
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City | BOISE
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State | ID
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Zip | 83709-5104
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Country | US
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Telephone | 208-407-0688
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Fax | 208-391-5550
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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 | LCPC-5420
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License Number State | ID
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