=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003607201
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELANIE JOHNSON M.ED, LPCA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2025
-----------------------------------------------------
Last Update Date | 05/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 BULLDOG LN # 6081
-----------------------------------------------------
City | HAZARD
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41701-6081
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-254-1035
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2465 HIGHWAY 805
-----------------------------------------------------
City | NEON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41840-9063
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 297235
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------