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NPI Code Detail

MEDICARE: COLEEN ELIZABETH JOHNSON MSW, LICSW, CMHS

MEDICARE: COLEEN ELIZABETH JOHNSON MSW, LICSW, CMHS
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
1101YM0800XMental Health CounselorSC61166287WA
2104100000XSocial WorkerSC61166287WA
31041C0700XClinical Social WorkerSC61166287WA
4106H00000XMarriage & Family TherapistLW61501471WA

General Provider Information

NPI Number : 1164092003
Entity Type Code : Individual
Provider Name (Legal Business Name) : COLEEN ELIZABETH JOHNSON MSW, LICSW, CMHS
Provider Business Mailing Address
First Line : 747 WESTPOINT CT
Second Line :
City : BURLINGTON
State : WA
Zip : 98233-2695
Country : US
Telephone Number : 360-846-7309
Fax Number :
Provider Business Practice Location Address
First Line : 2203 OLD HIGHWAY 99 S RD
Second Line :
City : MOUNT VERNON
State : WA
Zip : 98273-9009
Country : US
Telephone Number : 360-542-8810
Fax Number : 360-542-8811
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2021
Last Update Date : 07/30/2024

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