Provider Demographics
NPI:1750619748
Name:JOHNSON, ELISHAE SHAMONE (MA LLPC)
Entity type:Individual
Prefix:MS
First Name:ELISHAE
Middle Name:SHAMONE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49017-3418
Mailing Address - Country:US
Mailing Address - Phone:269-968-2811
Mailing Address - Fax:269-968-2651
Practice Address - Street 1:151 NORTH AVE
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-3418
Practice Address - Country:US
Practice Address - Phone:269-968-2811
Practice Address - Fax:269-968-2651
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-02
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010034101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1883502Medicaid