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General NPI Number Information
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NPI Number | 1851618433
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Entity Type | Individual
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Provider Name | JESSE JOHNSON LPC/MHSP
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Gender | Male
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Dates
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Enumeration Date | 04/22/2010
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 4 REBEL CV
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City | JACKSON
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State | TN
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Zip | 38301-7707
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Country | US
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Telephone | 731-234-2165
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Fax |
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Provider Business Mailing Address
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Address Line | 4 REBEL CV
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City | JACKSON
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State | TN
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Zip | 38301-7707
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Country | US
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Telephone | 731-234-2165
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 4913
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 0044
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License Number State | MS
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