Individual
MATTHEW JOHANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, LCPC, QSUDP
Contact information
Practice address
2131 S BONITO WAY, MERIDIAN, ID 83642-1659
(208) 202-4729
Mailing address
6407 W ROBERTSON DR, BOISE, ID 83709-2176
(208) 836-8247
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCPC-6475
ID
Other
Enumeration date
05/27/2014
Last updated
02/22/2019
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