Basic Information
| Provider Information | |||||||||
| NPI: | 1477984086 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | MICHELE | ||||||||
| MiddleName: | |||||||||
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| Credential: | MA, TEMP LMHC, CADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 SW ANKENY RD | ||||||||
| Address2: | |||||||||
| City: | ANKENY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 500239702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152892272 | ||||||||
| FaxNumber: | 5152890126 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 SW ANKENY RD | ||||||||
| Address2: | |||||||||
| City: | ANKENY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 500239702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152892272 | ||||||||
| FaxNumber: | 5152890126 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2013 | ||||||||
| LastUpdateDate: | 03/10/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 073865 | IA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YA0400X | 14021 | IA | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.