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General NPI Number Information
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NPI Number | 1982041430
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Entity Type | Individual
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Provider Name | PATTI JEAN JOHNSON LPC,NCC
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Gender | Female
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Dates
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Enumeration Date | 05/23/2013
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Last Update Date | 03/23/2022
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Provider Practice Location Address
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Address Line | 251 W ARROWROCK LN
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City | BOISE
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State | ID
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Zip | 83706-4802
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Country | US
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Telephone | 208-366-1607
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Fax | 208-366-1602
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Provider Business Mailing Address
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Address Line | 750 W USTICK RD STE 120
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City | MERIDIAN
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State | ID
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Zip | 83646-6133
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Country | US
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Telephone | 208-366-1607
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Fax | 208-366-1602
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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 | LPC-5253
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LCPC6122
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License Number State | ID
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