Provider Demographics
NPI:1033418462
Name:JOHNSON, ANDREW F (EDS LPC NCC EMDR-CT)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:F
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:EDS LPC NCC EMDR-CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 BROADWAY ST STE 102
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-7321
Mailing Address - Country:US
Mailing Address - Phone:573-271-2008
Mailing Address - Fax:573-271-2008
Practice Address - Street 1:1918 N KINGSHIGHWAY ST STE 102
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-2158
Practice Address - Country:US
Practice Address - Phone:573-271-2008
Practice Address - Fax:573-271-2008
Is Sole Proprietor?:No
Enumeration Date:2011-03-24
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019004054101YP2500X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional