Provider Demographics
NPI:1164162137
Name:JOHNSON, CHANELLE (LMFT)
Entity Type:Individual
Prefix:
First Name:CHANELLE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:CHANELLE
Other - Middle Name:
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 9214
Mailing Address - Street 2:
Mailing Address - City:CHANDLER HEIGHTS
Mailing Address - State:AZ
Mailing Address - Zip Code:85127-9214
Mailing Address - Country:US
Mailing Address - Phone:480-712-9799
Mailing Address - Fax:480-712-9811
Practice Address - Street 1:3651 E BASELINE RD STE E222
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2689
Practice Address - Country:US
Practice Address - Phone:480-712-9799
Practice Address - Fax:480-712-9811
Is Sole Proprietor?:No
Enumeration Date:2022-03-29
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMFT-15735106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist