Provider Demographics
NPI:1316234370
Name:JOHNSON-MITCHELL, DIANE TERESA (LPC-MH, QMHP)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:TERESA
Last Name:JOHNSON-MITCHELL
Suffix:
Gender:F
Credentials:LPC-MH, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6309 S PINEHURST CT
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2426
Mailing Address - Country:US
Mailing Address - Phone:605-929-8157
Mailing Address - Fax:
Practice Address - Street 1:6309 S PINEHURST CT
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2426
Practice Address - Country:US
Practice Address - Phone:605-929-8157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC-MH 2139101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional