Provider Demographics
NPI:1396059598
Name:JOHNSON, JESSI A
Entity type:Individual
Prefix:
First Name:JESSI
Middle Name:A
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JESSI
Other - Middle Name:
Other - Last Name:LEFHOLZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:109 S 10TH ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:64067-1364
Mailing Address - Country:US
Mailing Address - Phone:660-259-3900
Mailing Address - Fax:
Practice Address - Street 1:109 S 10TH ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MO
Practice Address - Zip Code:64067-1364
Practice Address - Country:US
Practice Address - Phone:660-259-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-29
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health