Provider Demographics
NPI:1326195975
Name:JOHNSON, MITA M (LPC, LMFT, LAC)
Entity type:Individual
Prefix:
First Name:MITA
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPC, LMFT, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 62359
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80962-2359
Mailing Address - Country:US
Mailing Address - Phone:303-808-8466
Mailing Address - Fax:
Practice Address - Street 1:685 CITADEL DR E STE 510
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5372
Practice Address - Country:US
Practice Address - Phone:303-808-8466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2024-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6450101YA0400X
CO764106H00000X
CO4215101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist