MEDICARE: MS. DANELL JOHNSON

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	C.2507741	OH

General Provider Information

NPI Number	:	1053143768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DANELL JOHNSON

Provider Business Mailing Address
First Line	:	560 BELL RD
Second Line	:
City	:	XENIA
State	:	OH
Zip	:	45385-7624
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5975 KENTSHIRE DR STE A
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45440-4254
Country	:	US
Telephone Number	:	937-210-9736
Fax Number	:

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

Provider Enumeration Date	:	08/20/2024
Last Update Date	:	03/13/2026

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