Doctor Name: | SHELLY MAE JOHNSON |
NPI Number: | 1326455510 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | L.P.C. |
License Number: | C1300335 |
Business Practice Address: | 22251 State Route 2 Archbold, OH - 435029452 |
Business Phone Number: | 4194451552 |
Business Fax Number: | 4194451401 |
Mailing Address: | 22251 State Route 2, ARCHBOLD |
State: | OH |
Postal Code: | 435029452 |
Phone Number: | 4194451552 |
Fax Number: | 4194451401 |
NPI Enumeration Date: | 07/19/2014 |
NPI Last Update Date: | 07/19/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | C1300335 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |