Provider Demographics
NPI:1902562473
Name:JOHNSON, JAMIE DENISE
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:DENISE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 W CHEYENNE RD APT 323
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-2510
Mailing Address - Country:US
Mailing Address - Phone:719-645-1099
Mailing Address - Fax:
Practice Address - Street 1:115 W CHEYENNE RD APT 323
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-2510
Practice Address - Country:US
Practice Address - Phone:719-645-1099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health