Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
Y | 103K00000X | Behavior Analyst | MI | |
N | 106S00000X | Behavior Technician |
NPI | 1003451006 |
---|---|
Provider Name | Megan Elinor Johnson |
First Address | Stuart, FL 34997-7462 |
Second Address | Grand Rapids, MI 49507-1526 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2019 |
Last Update Date | 09/08/2021 |