Provider Demographics
NPI:1043393887
Name:JOHNSON, EDITH W (LMFT)
Entity type:Individual
Prefix:MS
First Name:EDITH
Middle Name:W
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 E SPRINGFIELD DR
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTE
Mailing Address - State:PA
Mailing Address - Zip Code:16823-8284
Mailing Address - Country:US
Mailing Address - Phone:607-342-5455
Mailing Address - Fax:844-703-5304
Practice Address - Street 1:1033 E SPRINGFIELD DR
Practice Address - Street 2:
Practice Address - City:BELLEFONTE
Practice Address - State:PA
Practice Address - Zip Code:16823-8284
Practice Address - Country:US
Practice Address - Phone:607-342-5455
Practice Address - Fax:607-257-0740
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000036106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist