Individual
JEREMIAH JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
B.S., M.A., LCPC
Contact information
Practice address
1505 KASOLD DR STE 8, LAWRENCE, KS 66047-1601
(785) 542-9110
Mailing address
898 E 661 DIAG RD, LAWRENCE, KS 66047-9001
(785) 542-9110
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
03326
KS
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
07/03/2012
Last updated
11/14/2022
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