Provider Demographics
NPI:1174802318
Name:JOHNSON, KARLIANN K (LPCC)
Entity type:Individual
Prefix:MRS
First Name:KARLIANN
Middle Name:K
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:862 36TH AVE E
Mailing Address - Street 2:#211
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-7922
Mailing Address - Country:US
Mailing Address - Phone:218-831-1304
Mailing Address - Fax:
Practice Address - Street 1:1704 BELSLY BLVD
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-5274
Practice Address - Country:US
Practice Address - Phone:218-233-8068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-05
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND692-7-15-11-242101YM0800X
MN1076101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health