Provider Demographics
NPI:1992097018
Name:JOHNSON, REBECCA PATRICE (LIMFT)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:PATRICE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LIMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2349 VICTORY PKWY
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-2803
Mailing Address - Country:US
Mailing Address - Phone:513-510-5723
Mailing Address - Fax:
Practice Address - Street 1:2349 VICTORY PKWY
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45206-2803
Practice Address - Country:US
Practice Address - Phone:513-510-5723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-08
Last Update Date:2016-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF. 1600003106H00000X
CA80100106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist