Provider Demographics
NPI:1942015599
Name:JOHNSON, MICHELE MARIE (LPC-MH30656)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:MARIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPC-MH30656
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 N PALOMINO AVE
Mailing Address - Street 2:
Mailing Address - City:DELL RAPIDS
Mailing Address - State:SD
Mailing Address - Zip Code:57022-1120
Mailing Address - Country:US
Mailing Address - Phone:605-789-1405
Mailing Address - Fax:
Practice Address - Street 1:1104 N PALOMINO AVE
Practice Address - Street 2:
Practice Address - City:DELL RAPIDS
Practice Address - State:SD
Practice Address - Zip Code:57022-1120
Practice Address - Country:US
Practice Address - Phone:605-789-1405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD30656101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health