MEDICARE: KELLEY LYNN JOHNSON LCPC-S, LCAC

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	660	KS
2	101YP2500X	Professional Counselor	2362	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639296759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLEY LYNN JOHNSON LCPC-S, LCAC

Provider Business Mailing Address
First Line	:	PO BOX 1223
Second Line	:
City	:	GREAT BEND
State	:	KS
Zip	:	67530-1223
Country	:	US
Telephone Number	:	620-796-2206
Fax Number	:	620-796-2208

Provider Business Practice Location Address
First Line	:	809 S PATTON
Second Line	:	PO BOX 1223
City	:	GREAT BEND
State	:	KS
Zip	:	67530
Country	:	US
Telephone Number	:	620-796-2206
Fax Number	:	620-796-2208

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

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	04/02/2025

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Directions to “ KELLEY LYNN JOHNSON LCPC-S, LCAC” Practice Location

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