Provider Demographics
NPI:1679293559
Name:JOHNSON, ANGELA R (LMHC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:R
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:TUCUMCARI
Mailing Address - State:NM
Mailing Address - Zip Code:88401-2707
Mailing Address - Country:US
Mailing Address - Phone:575-282-2222
Mailing Address - Fax:575-282-2224
Practice Address - Street 1:325 S 1ST ST
Practice Address - Street 2:
Practice Address - City:TUCUMCARI
Practice Address - State:NM
Practice Address - Zip Code:88401-2707
Practice Address - Country:US
Practice Address - Phone:575-282-2222
Practice Address - Fax:575-282-2224
Is Sole Proprietor?:No
Enumeration Date:2022-08-31
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2024-0166101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health