Provider Demographics
NPI:1982149068
Name:JOHNSON, MELISSA LOUISE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:LOUISE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 BELMONT DR
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2345
Mailing Address - Country:US
Mailing Address - Phone:651-402-7974
Mailing Address - Fax:
Practice Address - Street 1:1350 BELMONT DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2345
Practice Address - Country:US
Practice Address - Phone:651-402-7974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-28
Last Update Date:2022-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2156106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist