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General NPI Number Information
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NPI Number | 1841652443
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Entity Type | Organization
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Legal Business Name | LYNDSEY JOHNSEN, LCSW
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Dates
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Enumeration Date | 03/22/2016
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Last Update Date | 04/17/2016
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Provider Practice Location Address
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Address Line | 901 E GROVE ST STE O
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City | BLOOMINGTON
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State | IL
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Zip | 61701-8539
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Country | US
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Telephone | 815-579-8350
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 111
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City | BLOOMINGTON
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State | IL
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Zip | 61702-0111
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Country | US
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Telephone | 815-579-8350
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | LYNDSEY JOHNSEN
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Credential | LCSW
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Telephone | 815-579-8350
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 149016349
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License Number State | IL
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