Individual
PAMELA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LMFT, LP
Contact information
Practice address
1751 COUNTY ROAD B W STE 100, ROSEVILLE, MN 55113-4037
(612) 719-5636
Mailing address
4775 DODD RD, EAGAN, MN 55123-2112
(612) 719-5636
(651) 846-4899
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
0541
MN
106H00000X
Marriage & Family Therapist
Primary
0736
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0G042JO
BCBS
MN
01
—
104309
UC
MN
01
—
17621
HP
MN
05
—
561853300
—
MN
01
—
570038
P1
MN
01
—
62-20741
UBH
MN
Enumeration date
07/19/2006
Last updated
03/17/2018
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