Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | IA | |
N | 101YM0800X | Mental Health Counselor |
NPI | 1003084260 |
---|---|
Provider Name | Miss Michelle Terry Johnson |
First Address | Newton, IA 50208-3249 |
Second Address | Newton, IA 50208-3249 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2008 |
Last Update Date | 11/02/2008 |