| Nisa Johnson Counseling Llc | |
|
1100 Beech St Bldg 10-1 Normal IL 61761-1568 | |
| (309) 750-0415 | |
| Not Available |
| Full Name | Nisa Johnson Counseling Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1100 Beech St Bldg 10-1, Normal, Illinois |
| Authorized Official Name and Position | Nisa Johnson (LICENSED CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 3097500415 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Nisa Johnson Counseling Llc 1100 Beech St Bldg 10-1 Normal IL 61761-1568 Ph: (309) 750-0415 | Nisa Johnson Counseling Llc 1100 Beech St Bldg 10-1 Normal IL 61761-1568 Ph: (309) 750-0415 |
| NPI Number | 1295469559 |
|---|---|
| Provider Enumeration Date | 07/13/2022 |
| Last Update Date | 10/26/2022 |
| Certification Date | 10/26/2022 |
| Medicare PECOS PAC ID | 5890163083 |
|---|---|
| Medicare Enrollment ID | O20221118001778 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295469559 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Nisa B Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255716205 PECOS PAC ID: 9537475298 Enrollment ID: I20150826002294 |
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