Provider Demographics
NPI:1114062312
Name:JOHNSON, MATTHEW DEAN (LPCC-S)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:DEAN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4581 S HILLS DR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-4469
Mailing Address - Country:US
Mailing Address - Phone:479-685-6595
Mailing Address - Fax:
Practice Address - Street 1:1807 PRESTWICK PL
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-1389
Practice Address - Country:US
Practice Address - Phone:479-685-6595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1000019-SUPV101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional