MEDICARE: MICHELE MARIE JOHNSON LPC-MH30656

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	30656	SD

General Provider Information

NPI Number	:	1942015599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELE MARIE JOHNSON LPC-MH30656

Provider Business Mailing Address
First Line	:	1104 N PALOMINO AVE
Second Line	:
City	:	DELL RAPIDS
State	:	SD
Zip	:	57022-1120
Country	:	US
Telephone Number	:	605-789-1405
Fax Number	:

Provider Business Practice Location Address
First Line	:	1104 N PALOMINO AVE
Second Line	:
City	:	DELL RAPIDS
State	:	SD
Zip	:	57022-1120
Country	:	US
Telephone Number	:	605-789-1405
Fax Number	:

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

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

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