Provider Demographics
NPI:1043791387
Name:JOHNSON, ELLEN MEREDITH (LMHC)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:MEREDITH
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC
Mailing Address - Street 1:10 MAIN ST STE 326
Mailing Address - Street 2:
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-1764
Mailing Address - Country:US
Mailing Address - Phone:845-419-1609
Mailing Address - Fax:
Practice Address - Street 1:10 MAIN ST STE 326
Practice Address - Street 2:
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-1764
Practice Address - Country:US
Practice Address - Phone:845-419-1609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008378101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health