Individual
AMANDA R JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1217 RIVERSIDE AVE, FORT COLLINS, CO 80524-3218
(970) 494-4200
Mailing address
4856 INNOVATION DR, FORT COLLINS, CO 80525-5539
(970) 494-4200
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
1041C0700X
Clinical Social Worker
34004308A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200816830A
—
IN
Enumeration date
06/30/2008
Last updated
11/06/2019
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