MEDICARE: MISS MICHELLE TERRY JOHNSON LPC, CADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	001060	IA

General Provider Information

NPI Number	:	1003084260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MICHELLE TERRY JOHNSON LPC, CADC

Provider Business Mailing Address
First Line	:	1313 PLEASANT DR STE 160
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50265-2327
Country	:	US
Telephone Number	:	515-635-5763
Fax Number	:

Provider Business Practice Location Address
First Line	:	1313 PLEASANT DR STE 160
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50265-2327
Country	:	US
Telephone Number	:	515-635-5763
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/11/2008
Last Update Date	:	11/10/2025

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