Provider Demographics
NPI:1679643407
Name:JOHNSON, MICHAEL BRYAN (LPCC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BRYAN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 CRESCENT DR
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44301-2062
Mailing Address - Country:US
Mailing Address - Phone:330-715-0865
Mailing Address - Fax:330-794-4262
Practice Address - Street 1:4466 DARROW RD
Practice Address - Street 2:SUITE 10
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-1866
Practice Address - Country:US
Practice Address - Phone:330-688-2414
Practice Address - Fax:330-319-6205
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE 0600303101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional