Provider Demographics
NPI:1154941474
Name:JOHNSON, KEVIN A (LMFT, LADC, CTP)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:A
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LMFT, LADC, CTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:992 INWOOD AVE N
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-6625
Mailing Address - Country:US
Mailing Address - Phone:612-842-9814
Mailing Address - Fax:
Practice Address - Street 1:992 INWOOD AVE N
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:MN
Practice Address - Zip Code:55128-6625
Practice Address - Country:US
Practice Address - Phone:612-842-9814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-17
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN305116101YA0400X
106H00000X
MN4354106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)