Provider Demographics
NPI:1932628393
Name:JOHANSEN, JUSTIN (LMFT)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:JOHANSEN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3060 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-7827
Mailing Address - Country:US
Mailing Address - Phone:754-971-2691
Mailing Address - Fax:866-272-2040
Practice Address - Street 1:7520 NW 5TH ST STE 203
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-1613
Practice Address - Country:US
Practice Address - Phone:754-837-1804
Practice Address - Fax:866-272-2040
Is Sole Proprietor?:No
Enumeration Date:2017-09-15
Last Update Date:2025-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT3379106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist