Individual
KATIE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LPCC
Contact information
Practice address
700 TWELVE OAKS CENTER DR STE 208, WAYZATA, MN 55391-4420
(612) 324-8702
(952) 209-1511
Mailing address
700 TWELVE OAKS CENTER DR STE 208, WAYZATA, MN 55391-4420
(612) 324-8702
(952) 209-1511
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
01595
MN
101YP2500X
Professional Counselor
01929
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1740678291
—
MN
Enumeration date
01/07/2015
Last updated
01/03/2020
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