| Melita Travis Johnson, Lmsw, Ccdp | |
|
770 Kenmoor Ave Se Ste 103 Grand Rapids MI 49546-8602 | |
| (616) 481-9337 | |
| (616) 719-3119 |
| Full Name | Melita Travis Johnson, Lmsw, Ccdp |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 770 Kenmoor Ave Se Ste 103, Grand Rapids, Michigan |
| Authorized Official Name and Position | Melita Travis Johnson (THERAPIST CONSULTANT) |
| Authorized Official Contact | 6164819337 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Melita Travis Johnson, Lmsw, Ccdp 1130 Elmdale Ave Ne Grand Rapids MI 49525-2632 Ph: (616) 481-9337 | Melita Travis Johnson, Lmsw, Ccdp 770 Kenmoor Ave Se Ste 103 Grand Rapids MI 49546-8602 Ph: (616) 481-9337 |
| NPI Number | 1417355322 |
|---|---|
| Provider Enumeration Date | 12/09/2014 |
| Last Update Date | 12/09/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417355322 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 6801063274 (Michigan) | Primary |
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