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NPI Code Detail

MEDICARE: MELINDA NICOLE JOHNSON M.A., PH.D.

MEDICARE: MELINDA NICOLE JOHNSON M.A., PH.D.
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
1101YP2500XProfessional CounselorC6110OR
2101YM0800XMental Health CounselorLH60133759WA

General Provider Information

NPI Number : 1467753590
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELINDA NICOLE JOHNSON M.A., PH.D.
Provider Business Mailing Address
First Line : 1015 12TH ST
Second Line :
City : WASHOUGAL
State : WA
Zip : 98671-1203
Country : US
Telephone Number : 360-903-1662
Fax Number :
Provider Business Practice Location Address
First Line : 1498 SE TECH CENTER PL STE 300
Second Line :
City : VANCOUVER
State : WA
Zip : 98683-5509
Country : US
Telephone Number : 360-619-2226
Fax Number : 360-326-9691
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/05/2010
Last Update Date : 04/15/2025

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