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1487066320
MATTHEW JOHANSEN
MERIDIAN, ID
NPI
1487066320
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YM0800X Counselor, Mental Health
(Licence: ID LCPC-6475)
Enumeration Date
2014-05-27
Last Update Date
2019-02-22
Business Address
MATTHEW JOHANSEN MS, LCPC, QSUDP
2131 S BONITO WAY
MERIDIAN, ID 83642-1659
Phone number: 208-202-4729
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Mailing Address
MATTHEW JOHANSEN MS, LCPC, QSUDP
6407 W ROBERTSON DR
BOISE, ID 83709-2176
Phone number: 208-836-8247
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