Provider Demographics
NPI:1245901131
Name:JOHNSON, MICHELLE DENISE (LPC)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:DENISE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W MIDLAND AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80863-5058
Mailing Address - Country:US
Mailing Address - Phone:719-551-7299
Mailing Address - Fax:
Practice Address - Street 1:400 W MIDLAND AVE STE 250
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80863-5058
Practice Address - Country:US
Practice Address - Phone:719-551-7299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-21
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0018678101Y00000X
COLPC.0019806101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor