Provider Demographics
NPI:1558829838
Name:MOUNTAINJOHNSON, KAREN (MA, LPCC)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:MOUNTAINJOHNSON
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:MOUNTAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPCC
Mailing Address - Street 1:790 CLEVELAND AVE S STE 217
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-3845
Mailing Address - Country:US
Mailing Address - Phone:612-300-3161
Mailing Address - Fax:
Practice Address - Street 1:790 CLEVELAND AVE S STE 217
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-3845
Practice Address - Country:US
Practice Address - Phone:612-454-1656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-06
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00152101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional