Basic Information
| Provider Information | |||||||||
| NPI: | 1841218427 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA, LPC, NCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 959 | ||||||||
| Address2: | |||||||||
| City: | STEVENS POINT | ||||||||
| State: | WI | ||||||||
| PostalCode: | 544810959 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7155444435 | ||||||||
| FaxNumber: | 8006812374 | ||||||||
| Practice Location | |||||||||
| Address1: | 3233A BUSINESS PARK DR STE 304 | ||||||||
| Address2: | |||||||||
| City: | STEVENS POINT | ||||||||
| State: | WI | ||||||||
| PostalCode: | 544828861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7155444435 | ||||||||
| FaxNumber: | 7159524995 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 11/08/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 3180-125 | WI | N | Behavioral Health & Social Service Providers | Counselor | 101YP2500X | 3180-125 | WI | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 62743 | 01 | WI | MULTIPLAN/WPPN | OTHER | 138137 | 01 | MANAGED HEALTH NETWORK | OTHER | 79453 | 01 | WI | SECURITY HEALTH PLAN | OTHER | 526825 | 01 | VALUEOPTIONS | OTHER | 40934000 | 05 | WI | MEDICAID | 2180399 | 01 | CIGNA BEHAVIORAL HEALTH | OTHER | 391640073002 | 01 | TRICARE | OTHER |