Individual
T KELLY JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LAC
Contact information
Practice address
726 S WASHINGTON AVE, MADISON, SD 57042-3519
(605) 270-0347
Mailing address
726 S WASHINGTON AVE, MADISON, SD 57042-3519
(605) 270-0347
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
SD
Other
Enumeration date
11/21/2006
Last updated
04/14/2015
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