Provider Demographics
NPI:1023536059
Name:JOHNSON, SHANTELL ALEAH (LPC-MHSP)
Entity type:Individual
Prefix:
First Name:SHANTELL
Middle Name:ALEAH
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 WOODLAND STREET
Mailing Address - Street 2:#60101
Mailing Address - City:NASHVILLLE
Mailing Address - State:TN
Mailing Address - Zip Code:37206-0101
Mailing Address - Country:US
Mailing Address - Phone:810-887-9406
Mailing Address - Fax:
Practice Address - Street 1:514 DONALD ST
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-2036
Practice Address - Country:US
Practice Address - Phone:615-859-8950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-30
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4872101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional