Individual
JOSH JOHANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
610 MAIN ST, LAFAYETTE, IN 47901-1451
(765) 423-2638
Mailing address
415 N 26TH ST STE 102, LAFAYETTE, IN 47904-2855
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
87001632A
IN
Other
Enumeration date
08/07/2020
Last updated
08/07/2020
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