Individual
MS. LISA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
9850 W ST LUKES DR STE 320, NAMPA, ID 83687-7912
(208) 505-2222
(208) 205-7666
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
3122
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LCPC3122
LICENSE
ID
Enumeration date
01/29/2007
Last updated
01/16/2024
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