Provider Demographics
NPI:1891842472
Name:JOHNDRO, MICHAEL WILLIAM (LMFT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:WILLIAM
Last Name:JOHNDRO
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:634 S BAILEY ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-6330
Mailing Address - Country:US
Mailing Address - Phone:907-745-7080
Mailing Address - Fax:907-745-6263
Practice Address - Street 1:634 S BAILEY ST
Practice Address - Street 2:SUITE 207
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-6330
Practice Address - Country:US
Practice Address - Phone:907-745-7080
Practice Address - Fax:907-745-6263
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK86106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK561028000OtherMAGELLAN
2383280OtherCIGNA
AK421545189OtherBLUE GROUP GROUP BILLING
AKMH9931Medicaid
AK561028000OtherAETNA
45-5503677OtherCOMMERICAL INSURANCE