IndividualActive
Kim Johnson, MHR, D.MIN, CSAYC
NPI 1508277401 · Psychiatric Residential Treatment Facility · Indianapolis, IN
Provider details
- NPI number
- 1508277401
- Entity type
- Individual
- Primary specialty
- Psychiatric Residential Treatment FacilityResidential Treatment Facilities
- Credential
- MHR, D.MIN, CSAYC
- Sex
- Female
- Sole proprietor
- Yes
Specialties & taxonomies
Residential Treatment Facilities
- Mental Health Counselor101YM0800X
Behavioral Health & Social Service Providers
Practice location
1404 S State Ave
Indianapolis, IN 46203-2009
Phone: (317) 783-4003
Fax: (317) 780-4810
Approximate (ZIP-level) locationGet directions
Mailing address
1404 S State Ave
Indianapolis, IN 46203-2009
Registry dates
- Enumerated
- 2014-05-13
- Last updated
- 2014-05-13
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.