Provider Demographics
NPI:1467061556
Name:JOHNSON, BRETT (LMSW)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 E GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CENTER
Mailing Address - State:MI
Mailing Address - Zip Code:49254-1514
Mailing Address - Country:US
Mailing Address - Phone:269-512-4455
Mailing Address - Fax:
Practice Address - Street 1:2820 BAKER RD STE 100
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MI
Practice Address - Zip Code:48130-1196
Practice Address - Country:US
Practice Address - Phone:734-580-2920
Practice Address - Fax:734-580-2922
Is Sole Proprietor?:No
Enumeration Date:2020-07-24
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011074681041C0700X
MI68011151851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical