Provider Demographics
NPI:1346442407
Name:JOHNSON, JUNE (LSAA)
Entity type:Individual
Prefix:MS
First Name:JUNE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LSAA
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 2409
Mailing Address - Street 2:
Mailing Address - City:SHIPROCK
Mailing Address - State:NM
Mailing Address - Zip Code:87420-2409
Mailing Address - Country:US
Mailing Address - Phone:505-368-1048
Mailing Address - Fax:505-368-1055
Practice Address - Street 1:HWY 491 N., PINON ST.
Practice Address - Street 2:
Practice Address - City:SHIPROCK
Practice Address - State:NM
Practice Address - Zip Code:87420-1830
Practice Address - Country:US
Practice Address - Phone:505-368-1048
Practice Address - Fax:505-368-1055
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5276101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)