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General NPI Number Information
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NPI Number | 1619399532
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Entity Type | Individual
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Provider Name | ELLEN M JOHNSON LMFT
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Gender | Female
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Dates
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Enumeration Date | 01/12/2014
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Last Update Date | 04/15/2022
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Provider Practice Location Address
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Address Line | 40 E CENTER ST STE 12
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City | FALLON
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State | NV
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Zip | 89406-3474
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Country | US
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Telephone | 775-432-7995
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Fax | 775-420-4408
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Provider Business Mailing Address
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Address Line | PO BOX 104
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City | FALLON
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State | NV
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Zip | 89407-0104
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Country | US
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Telephone | 775-432-7995
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Fax | 775-420-4408
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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 | 00530-LC
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 2589
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License Number State | NV
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