MEDICARE: DANARA JOHNSON LCSW, LAC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	ACD.0000918	CO
2	1041C0700X	Clinical Social Worker	CSW.09924827	CO

General Provider Information

NPI Number	:	1093283186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANARA JOHNSON LCSW, LAC

Provider Business Mailing Address
First Line	:	25619 PLEASANT PARK RD
Second Line	:
City	:	CONIFER
State	:	CO
Zip	:	80433-7610
Country	:	US
Telephone Number	:	720-878-2955
Fax Number	:

Provider Business Practice Location Address
First Line	:	190 E 9TH AVE STE 290
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80203-2744
Country	:	US
Telephone Number	:	720-878-2955
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2018
Last Update Date	:	11/06/2018

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