Provider Demographics
NPI:1154104164
Name:JOHNSON, KURRISSA K (LCMHCA)
Entity type:Individual
Prefix:
First Name:KURRISSA
Middle Name:K
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 ROYAL PKWY UNIT 292968
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37229-4087
Mailing Address - Country:US
Mailing Address - Phone:615-525-8746
Mailing Address - Fax:
Practice Address - Street 1:4001 CANE RIDGE PKWY
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-4602
Practice Address - Country:US
Practice Address - Phone:615-525-8746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC04395101YM0800X
101YM0800X
NCA18927101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health