Individual
MS. TRACY DARLENE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PLPC
Contact information
Practice address
1611 TOWNE DR, COLUMBIA, MO 65202-2339
(573) 474-6600
(573) 474-5995
Mailing address
1611 TOWNE DR, COLUMBIA, MO 65202-2339
(573) 474-6600
(573) 474-5995
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2020010925
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1063586519
—
MO
Enumeration date
04/15/2020
Last updated
04/15/2020
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