MEDICARE: MRS. ALLISON G. JOHNSEN M.A., LCPC

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	180-005892	IL

General Provider Information

NPI Number	:	1245214154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALLISON G. JOHNSEN M.A., LCPC

Provider Business Mailing Address
First Line	:	41W161 WHITNEY RD
Second Line	:
City	:	SAINT CHARLES
State	:	IL
Zip	:	60175-8571
Country	:	US
Telephone Number	:	630-222-6177
Fax Number	:

Provider Business Practice Location Address
First Line	:	2445 DEAN ST UNIT A
Second Line	:
City	:	SAINT CHARLES
State	:	IL
Zip	:	60175-4828
Country	:	US
Telephone Number	:	630-222-6177
Fax Number	:

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

Provider Enumeration Date	:	12/05/2005
Last Update Date	:	05/26/2019

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