Provider Demographics
NPI:1235327891
Name:JOHNSON, JANET PROCTOR (MED LMFT)
Entity type:Individual
Prefix:MRS
First Name:JANET
Middle Name:PROCTOR
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MED LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 IRVINE AVE NW
Mailing Address - Street 2:LOT 737
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-4222
Mailing Address - Country:US
Mailing Address - Phone:218-333-3943
Mailing Address - Fax:
Practice Address - Street 1:1741 15TH ST NW
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-8755
Practice Address - Country:US
Practice Address - Phone:218-751-6553
Practice Address - Fax:218-751-1846
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN923106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist