Individual
AMY EDWARDSON JOHANNESEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A., LPC, LMHC
Contact information
Practice address
504 MAIN ST, STE. 444, LEWISTON, ID 83501-1803
(208) 750-3000
(208) 750-1244
Mailing address
504 MAIN ST, STE. 444, LEWISTON, ID 83501-1803
(208) 750-3000
(208) 750-1244
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LH00005257
WA
101YP2500X
Professional Counselor
Primary
LPC-5580
ID
Other
Enumeration date
03/17/2015
Last updated
03/17/2015
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