Provider Demographics
NPI:1528781747
Name:JOHNSON, EMILY CATHERINE (LMFT)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:CATHERINE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1722 CRYSTAL LN
Mailing Address - Street 2:
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-2849
Mailing Address - Country:US
Mailing Address - Phone:507-838-7603
Mailing Address - Fax:
Practice Address - Street 1:625 3RD AVE NW
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-4219
Practice Address - Country:US
Practice Address - Phone:763-780-3307
Practice Address - Fax:833-777-2781
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3644106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist