Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | C0003372 | OH |
NPI | 1003264102 |
---|---|
Provider Name | Melvin Douglas Johnson |
First Address | Toledo, OH 43604-6774 |
Second Address | Toledo, OH 43604-6774 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2016 |
Last Update Date | 30/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2585582 | (05) | OH |