Provider Demographics
NPI:1487071577
Name:JOHNSON, ROBERT M (LCPC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 N WACKER DR # 245
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-2800
Mailing Address - Country:US
Mailing Address - Phone:312-316-3366
Mailing Address - Fax:312-491-0735
Practice Address - Street 1:1535 W ADAMS ST
Practice Address - Street 2:THE COACH HOUSE
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-2409
Practice Address - Country:US
Practice Address - Phone:312-316-3366
Practice Address - Fax:312-491-0735
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-26
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.008959101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional