Provider Demographics
NPI:1063876761
Name:JOHNSON, MADELINE DAVIS (LMFT, ATR)
Entity type:Individual
Prefix:MRS
First Name:MADELINE
Middle Name:DAVIS
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMFT, ATR
Other - Prefix:MS
Other - First Name:MADELINE
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8401 WAYZATA BLVD
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55426
Mailing Address - Country:US
Mailing Address - Phone:763-544-1006
Mailing Address - Fax:
Practice Address - Street 1:17901 MAPLE HILL RD
Practice Address - Street 2:
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-2732
Practice Address - Country:US
Practice Address - Phone:952-237-7989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-08
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3092106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist