Provider Demographics
NPI:1689812299
Name:JOHNSON, LINDSEY KAYE (LMFT)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:KAYE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:KAYE
Other - Last Name:PETERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4660 SLATER RD STE 120
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-4048
Mailing Address - Country:US
Mailing Address - Phone:612-276-2462
Mailing Address - Fax:612-246-3682
Practice Address - Street 1:4660 SLATER RD STE 120
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-4048
Practice Address - Country:US
Practice Address - Phone:612-276-2462
Practice Address - Fax:612-246-3682
Is Sole Proprietor?:No
Enumeration Date:2009-02-04
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
IA124387106H00000X
MN2245106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health