Provider Demographics
NPI:1003084260
Name:JOHNSON, MICHELLE TERRY (LPC, CADC)
Entity Type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:TERRY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPC, CADC
Other - Prefix:MISS
Other - First Name:SHELLY
Other - Middle Name:TERRY
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:306 N 3RD AVE E
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:IA
Mailing Address - Zip Code:50208-3249
Mailing Address - Country:US
Mailing Address - Phone:641-792-4012
Mailing Address - Fax:641-791-0697
Practice Address - Street 1:306 N 3RD AVE E
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:IA
Practice Address - Zip Code:50208-3249
Practice Address - Country:US
Practice Address - Phone:641-792-4012
Practice Address - Fax:641-791-0697
Is Sole Proprietor?:No
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA101YA0400X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health