Healthcare Provider Details

I. General information

NPI: 1083943864
Provider Name (Legal Business Name): MELISSA L JOHNSON LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2009
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 FAIR RD
SIDNEY OH
45365-2951
US

IV. Provider business mailing address

980 FAIR RD
SIDNEY OH
45365-2951
US

V. Phone/Fax

Practice location:
  • Phone: 937-497-2225
  • Fax: 937-497-2204
Mailing address:
  • Phone: 937-497-2225
  • Fax: 937-497-2204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberLSP.01315
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE-0002610
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: