Provider Demographics
NPI:1861095358
Name:JOHNSON, REBECCA L (LPC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 GARDEN CTR STE 2
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-7317
Mailing Address - Country:US
Mailing Address - Phone:720-381-4085
Mailing Address - Fax:
Practice Address - Street 1:80 GARDEN CTR STE 2
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-7317
Practice Address - Country:US
Practice Address - Phone:720-381-4085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0005320101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1861095358OtherREBECCA JOHNSON LLC