Provider Demographics
NPI:1225168651
Name:JOHNSON, MICHAEL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5230 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46953-5778
Mailing Address - Country:US
Mailing Address - Phone:765-674-2208
Mailing Address - Fax:765-674-3273
Practice Address - Street 1:5230 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46953-5778
Practice Address - Country:US
Practice Address - Phone:765-674-2208
Practice Address - Fax:765-674-3273
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34001611A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN2036859OtherCIGNA BEHAVIORAL HEALTH
IN7887032OtherAETNA
IN459411000OtherMAGELLAN
IN000000175676OtherBLUE CROSS BLUE SHIELD
IN7887032OtherAETNA