Provider Demographics
NPI:1114145489
Name:JOHNSON, LINDA BENTLEY (MS, LLP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:BENTLEY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1747 HIGH POINTE LN
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-9584
Mailing Address - Country:US
Mailing Address - Phone:734-761-2124
Mailing Address - Fax:
Practice Address - Street 1:37634 ENTERPRISE CT
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-3440
Practice Address - Country:US
Practice Address - Phone:248-553-0902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI012750103TB0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical