Provider Demographics
NPI:1053741066
Name:JOHNSON, MEGAN ELIZABETH (LMHC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:ELIZABETH
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 342
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:NY
Mailing Address - Zip Code:13808-0342
Mailing Address - Country:US
Mailing Address - Phone:607-437-4068
Mailing Address - Fax:
Practice Address - Street 1:5172 WESTERN TPKE
Practice Address - Street 2:
Practice Address - City:ALTAMONT
Practice Address - State:NY
Practice Address - Zip Code:12009-3810
Practice Address - Country:US
Practice Address - Phone:518-464-1511
Practice Address - Fax:518-464-9198
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005742-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health