Provider Demographics
NPI:1770782955
Name:JOHNSON, MICHELE WATZKE (LMHC, LMFT)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:WATZKE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMHC, LMFT
Other - Prefix:DR
Other - First Name:MICHELE
Other - Middle Name:
Other - Last Name:PAHL-MONSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EDD, BCPC, LMFT
Mailing Address - Street 1:422 MEDICO LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4786
Mailing Address - Country:US
Mailing Address - Phone:505-954-1365
Mailing Address - Fax:
Practice Address - Street 1:422 MEDICO LN
Practice Address - Street 2:SUITE A
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4786
Practice Address - Country:US
Practice Address - Phone:505-954-1365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0142451101YM0800X
1041C0700X
NM0145811106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical