Provider Demographics
NPI:1538973904
Name:JOHNSON, GREG (LSW)
Entity type:Individual
Prefix:
First Name:GREG
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4586 RAINWATER LN
Mailing Address - Street 2:
Mailing Address - City:WHITESTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:46075-6225
Mailing Address - Country:US
Mailing Address - Phone:317-617-9046
Mailing Address - Fax:
Practice Address - Street 1:2010 BRENTWOOD DR
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46011-4042
Practice Address - Country:US
Practice Address - Phone:765-393-0063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33012838A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker