Individual
MALLORY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPCC
Contact information
Practice address
11103 PARK RD, LOUISVILLE, KY 40223-2424
(502) 753-5524
Mailing address
4536 S 3RD ST, LOUISVILLE, KY 40214-1930
(859) 760-2382
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
173555
KY
101YP2500X
Professional Counselor
Primary
265944
KY
Other
Enumeration date
09/27/2019
Last updated
09/30/2020
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