Provider Demographics
NPI:1336539139
Name:JOHNSON, MACHELLE (LPC/MHSP)
Entity Type:Individual
Prefix:
First Name:MACHELLE
Middle Name:
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 1:7209 HAMILTON ACRES CIR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-8623
Mailing Address - Country:US
Mailing Address - Phone:423-499-9335
Mailing Address - Fax:423-499-9334
Practice Address - Street 1:2600 EXECUTIVE PARK NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-2705
Practice Address - Country:US
Practice Address - Phone:423-458-4122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-31
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3509101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ017960Medicaid