MEDICARE: MICHELE JOHNSON LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	6801087772	MI

General Provider Information

NPI Number	:	1144980046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELE JOHNSON LMSW

Provider Business Mailing Address
First Line	:	7650 COOLEY LAKE RD UNIT 103
Second Line	:
City	:	UNION LAKE
State	:	MI
Zip	:	48387-7004
Country	:	US
Telephone Number	:	248-882-9530
Fax Number	:

Provider Business Practice Location Address
First Line	:	2632 HUNTER HEIGHTS DR.
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48324
Country	:	US
Telephone Number	:	248-934-9380
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2021
Last Update Date	:	12/20/2021

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Directions to “ MICHELE JOHNSON LMSW” Practice Location

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