MEDICARE: KRISTEN JOHNSON COUNSELING AND CONSULTING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1033702139
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KRISTEN JOHNSON COUNSELING AND CONSULTING, LLC

Provider Business Mailing Address
First Line	:	30 LINK RD
Second Line	:
City	:	SOUTH BURLINGTON
State	:	VT
Zip	:	05403-8018
Country	:	US
Telephone Number	:	802-598-8168
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 LINK RD
Second Line	:
City	:	SOUTH BURLINGTON
State	:	VT
Zip	:	05403-8018
Country	:	US
Telephone Number	:	802-598-8168
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CLINICIAN
Name	:	KRISTEN L JOHNSON
Credential	:	LCMHC
Telephone Number	:	802-598-8168

Provider Enumeration Date	:	02/19/2021
Last Update Date	:	02/19/2021

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