Provider Demographics
NPI:1588442925
Name:JOHNSON, TAYLOR ELAINE (PCLC)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:ELAINE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 STEPHENS AVE
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-6659
Mailing Address - Country:US
Mailing Address - Phone:506-829-9515
Mailing Address - Fax:
Practice Address - Street 1:1511 S RUSSELL ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-3629
Practice Address - Country:US
Practice Address - Phone:406-829-9515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-PCLC-LIC-64676101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health