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General NPI Number Information
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NPI Number | 1841061421
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Entity Type | Individual
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Provider Name | ABBY LEIGH JOHNSON LPC, LMHC, ATR
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Gender | Female
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Dates
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Enumeration Date | 01/11/2024
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Last Update Date | 01/11/2024
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Provider Practice Location Address
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Address Line | NORTHSTAR PLAZA, 65 STATE HWY 522, UNIT 65B1
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City | EL PRADO
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State | NM
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Zip | 87529
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Country | US
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Telephone | 505-230-8291
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 87
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City | OJO CALIENTE
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State | NM
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Zip | 87549-0087
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Country | US
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Telephone | 505-230-8291
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Fax |
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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 | CMH0223951
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC.0020193
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License Number State | CO
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