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General NPI Number Information
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NPI Number | 1386046498
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Entity Type | Individual
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Provider Name | MELISSA NICOLE JOHNSTON BCBA, LBA
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Gender | Female
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Dates
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Enumeration Date | 09/19/2014
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Last Update Date | 03/05/2020
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Provider Practice Location Address
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Address Line | 43334 7 MILE RD STE 200
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City | NORTHVILLE
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State | MI
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Zip | 48167-2249
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Country | US
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Telephone | 810-252-4420
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Fax |
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Provider Business Mailing Address
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Address Line | 5 REVERE DR STE 120
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City | NORTHBROOK
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State | IL
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Zip | 60062-8005
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Country | US
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Telephone | 847-306-9843
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 11518081
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License Number State | MI
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