Provider Demographics
NPI:1346605623
Name:JOHNSON, RACHEL MARIE (MA, LPC, IMH-E-II)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:MARIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA, LPC, IMH-E-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 CAMBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001-4422
Mailing Address - Country:US
Mailing Address - Phone:269-743-9793
Mailing Address - Fax:
Practice Address - Street 1:426 SOLON ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49006-4289
Practice Address - Country:US
Practice Address - Phone:269-353-7607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-30
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013780101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional