Individual
KIM JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MHR, D.MIN, CSAYC
Contact information
Practice address
1404 S STATE AVE, INDIANAPOLIS, IN 46203-2009
(317) 783-4003
(317) 780-4810
Mailing address
1404 S STATE AVE, INDIANAPOLIS, IN 46203-2009
(317) 783-4003
(317) 780-4810
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
323P00000X
Psychiatric Residential Treatment Facility
Primary
—
—
Other
Enumeration date
05/13/2014
Last updated
05/13/2014
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