Provider Demographics
NPI:1154085595
Name:JOHNSON, WHITNEY TYES (M ED, LSC, LPC)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:TYES
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:M ED, LSC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 RIVIERA WAY
Mailing Address - Street 2:
Mailing Address - City:MACEDONIA
Mailing Address - State:OH
Mailing Address - Zip Code:44056-2346
Mailing Address - Country:US
Mailing Address - Phone:216-973-8318
Mailing Address - Fax:
Practice Address - Street 1:18860 BAGLEY RD
Practice Address - Street 2:STE 404
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130
Practice Address - Country:US
Practice Address - Phone:440-234-8746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-22
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2103444-TRNE101YM0800X
OHC.2204172101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health