MEDICARE: ALISA R JOHNSON LPCC

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	101YP2500X	Professional Counselor	3612	MN

General Provider Information

NPI Number	:	1598475212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISA R JOHNSON LPCC

Provider Business Mailing Address
First Line	:	12706 COUNTY ROAD 27 NW
Second Line	:
City	:	PENNOCK
State	:	MN
Zip	:	56279-8510
Country	:	US
Telephone Number	:	320-295-3450
Fax Number	:

Provider Business Practice Location Address
First Line	:	217 INDUSTRIAL DR SW
Second Line	:
City	:	WILLMAR
State	:	MN
Zip	:	56201-2989
Country	:	US
Telephone Number	:	320-295-3450
Fax Number	:

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

Provider Enumeration Date	:	12/05/2022
Last Update Date	:	12/05/2022

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Directions to “ ALISA R JOHNSON LPCC” Practice Location

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