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General NPI Number Information
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NPI Number | 1861958324
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Entity Type | Individual
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Provider Name | MICHELLE MARIE JOHNSON-DUPRE LPC
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Gender | Female
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Dates
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Enumeration Date | 02/20/2019
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Last Update Date | 02/20/2019
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Provider Practice Location Address
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Address Line | 333 GRAND AVE STE 205
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City | SAINT PAUL
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State | MN
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Zip | 55102-2583
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Country | US
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Telephone | 651-303-4680
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Fax |
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Provider Business Mailing Address
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Address Line | 174 JUNIPER ST
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City | MAHTOMEDI
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State | MN
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Zip | 55115-1522
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Country | US
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Telephone | 651-303-4680
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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 | 7235-125
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License Number State | WI
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