Healthcare Provider Details

I. General information

NPI: 1427692003
Provider Name (Legal Business Name): MELISSA JOHNSON M.ED, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2019
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 W MAIN ST STE 103
KENT OH
44240-2461
US

IV. Provider business mailing address

PO BOX 24242
CLEVELAND OH
44124-0242
US

V. Phone/Fax

Practice location:
  • Phone: 216-839-2273
  • Fax:
Mailing address:
  • Phone: 216-839-2273
  • Fax: 216-896-0735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.2505398
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: