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General NPI Number Information
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NPI Number | 1467753590
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Entity Type | Individual
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Provider Name | MELINDA NICOLE JOHNSON M.A., PH.D.
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Gender | Female
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Dates
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Enumeration Date | 11/05/2010
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | 1498 SE TECH CENTER PL STE 300
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City | VANCOUVER
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State | WA
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Zip | 98683-5509
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Country | US
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Telephone | 360-619-2226
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Fax | 360-326-9691
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Provider Business Mailing Address
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Address Line | 1015 12TH ST
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City | WASHOUGAL
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State | WA
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Zip | 98671-1203
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Country | US
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Telephone | 360-903-1662
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | C6110
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LH60133759
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License Number State | WA
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