Healthcare Provider Details

I. General information

NPI: 1326957937
Provider Name (Legal Business Name): MRS. MELANIE ULRICH JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2339 N HOSTA DR
FAYETTEVILLE AR
72704-6377
US

IV. Provider business mailing address

2339 N HOSTA DR
FAYETTEVILLE AR
72704-6377
US

V. Phone/Fax

Practice location:
  • Phone: 479-404-0028
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: