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General NPI Number Information
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NPI Number | 1699864660
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Entity Type | Individual
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Provider Name | TIMOTHY ROGER JOHNSON MA LMFT
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Gender | Male
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 06/08/2018
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Provider Practice Location Address
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Address Line | 217 INDUSTRIAL DR SW
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City | WILLMAR
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State | MN
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Zip | 56201
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Country | US
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Telephone | 320-905-0795
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Fax | 320-200-7480
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Provider Business Mailing Address
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Address Line | PO BOX 284
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City | WILLMAR
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State | MN
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Zip | 56201-0284
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Country | US
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Telephone | 320-905-0795
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Fax | 320-205-0030
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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 | 1071
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License Number State | MN
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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 | 1071
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License Number State | MN
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