Provider Demographics
NPI:1548681737
Name:JOHNSON, MELANIE (LPCC)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC
Mailing Address - Street 1:14300 NICOLLET CT STE 130
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55306-3422
Mailing Address - Country:US
Mailing Address - Phone:952-435-8814
Mailing Address - Fax:952-435-7705
Practice Address - Street 1:14300 NICOLLET CT STE 130
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55306-3422
Practice Address - Country:US
Practice Address - Phone:952-435-8814
Practice Address - Fax:952-435-7705
Is Sole Proprietor?:No
Enumeration Date:2013-12-15
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00692101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional