1245214154 NPI number — MRS. ALLISON G. JOHNSEN M.A., LCPC

Table of content: MISS AHJUARI TRINITY FRANCHELLE MONCREASE (NPI 1366934051)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245214154 NPI number — MRS. ALLISON G. JOHNSEN M.A., LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSEN
Provider First Name:
ALLISON
Provider Middle Name:
G.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.A., LCPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PARKS
Provider Other First Name:
ALLISON
Provider Other Middle Name:
G.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.A., LCPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1245214154
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/26/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
41W161 WHITNEY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT CHARLES
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60175-8571
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-222-6177
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2445 DEAN ST UNIT A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT CHARLES
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60175-4828
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-222-6177
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/05/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  180-005892 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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