Provider Demographics
NPI:1447438163
Name:JOHNSON, CATHY MARGARET (PLMHP)
Entity type:Individual
Prefix:MRS
First Name:CATHY
Middle Name:MARGARET
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4829 CALVERT ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-3905
Mailing Address - Country:US
Mailing Address - Phone:402-488-2141
Mailing Address - Fax:402-488-2266
Practice Address - Street 1:4829 CALVERT ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-3905
Practice Address - Country:US
Practice Address - Phone:402-488-2141
Practice Address - Fax:402-488-2266
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8354101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE71-090261926Medicaid