Provider Demographics
NPI:1578386983
Name:JOHNSON, JAMES DOUGLAS
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:DOUGLAS
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:937 BELLOWS ST
Mailing Address - Street 2:
Mailing Address - City:WEST SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55118-1318
Mailing Address - Country:US
Mailing Address - Phone:612-840-6263
Mailing Address - Fax:
Practice Address - Street 1:937 BELLOWS ST
Practice Address - Street 2:
Practice Address - City:WEST SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118-1318
Practice Address - Country:US
Practice Address - Phone:612-840-6263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional