Provider Demographics
NPI:1144907247
Name:JOHNSON, KATE LYNN-KUSCHEL (MA, LPC)
Entity type:Individual
Prefix:
First Name:KATE
Middle Name:LYNN-KUSCHEL
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 MEADOWSWEET LN
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49097-9492
Mailing Address - Country:US
Mailing Address - Phone:269-929-5719
Mailing Address - Fax:
Practice Address - Street 1:1117 MEADOWSWEET LN
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MI
Practice Address - Zip Code:49097-9492
Practice Address - Country:US
Practice Address - Phone:269-929-5719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401223558APP23101YM0800X, 101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional