Provider Demographics
NPI:1609600071
Name:JOHNSON, IESHA (MS, LMHCA)
Entity type:Individual
Prefix:
First Name:IESHA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS, LMHCA
Other - Prefix:
Other - First Name:IESHA
Other - Middle Name:
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:6017 E 115TH LN
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46307-0240
Mailing Address - Country:US
Mailing Address - Phone:219-292-8345
Mailing Address - Fax:
Practice Address - Street 1:7725 BROADWAY
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-4731
Practice Address - Country:US
Practice Address - Phone:219-736-1000
Practice Address - Fax:219-736-9699
Is Sole Proprietor?:No
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99124301A101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor