Provider Demographics
NPI:1548658792
Name:JOHNSON, TESS (MS, LPCC)
Entity type:Individual
Prefix:
First Name:TESS
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:579 RIVER DR
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-6020
Mailing Address - Country:US
Mailing Address - Phone:701-521-0503
Mailing Address - Fax:
Practice Address - Street 1:25 1ST AVE W STE 160
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-5157
Practice Address - Country:US
Practice Address - Phone:701-787-1100
Practice Address - Fax:701-787-1600
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-22
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND813-12-15-14A101YP2500X
ND813-12-15-14-352101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional