Provider Demographics
NPI:1770388746
Name:JOHNSON, LORETTA (MA, LLPC)
Entity type:Individual
Prefix:MRS
First Name:LORETTA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA, LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-5733
Mailing Address - Country:US
Mailing Address - Phone:269-375-4363
Mailing Address - Fax:269-375-4362
Practice Address - Street 1:1090 N 10TH ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-5733
Practice Address - Country:US
Practice Address - Phone:269-375-4363
Practice Address - Fax:269-375-4362
Is Sole Proprietor?:No
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451024104101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional