Individual
MARY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
803 W BAYOU PINES DR STE D, LAKE CHARLES, LA 70601-7096
(337) 437-8458
Mailing address
717 BURLEY ST APT A, PICAYUNE, MS 39466-5101
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
07/07/2016
Last updated
07/07/2016
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