Healthcare Provider Details

I. General information

NPI: 1053226274
Provider Name (Legal Business Name): MELINDA JOHNSON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3472 NE SAVANNAH RD STE 111
JENSEN BEACH FL
34957-3758
US

IV. Provider business mailing address

2732 NW CRYSTAL LAKE DR
JENSEN BEACH FL
34957-4461
US

V. Phone/Fax

Practice location:
  • Phone: 772-214-3864
  • Fax:
Mailing address:
  • Phone: 571-332-5003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MELINDA JOHNSON
Title or Position: OWNER
Credential: LCSW
Phone: 571-332-5003