Individual
MRS. AMANDA INEZ JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
417 S INDIANA AVE, TRINIDAD, CO 81082-3126
(719) 846-4416
(719) 846-6408
Mailing address
41 MONTEBELLO RD STE 204, PUEBLO, CO 81001-1379
(719) 545-2746
(719) 545-4100
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
2118
AL
Other
Enumeration date
09/20/2006
Last updated
07/10/2020
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