Provider Demographics
NPI:1417119884
Name:MELANIE JOHNSON, LCSW, LLC
Entity type:Organization
Organization Name:MELANIE JOHNSON, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, BILLING CO.
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BEESON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-863-2593
Mailing Address - Street 1:9979 ORANGE BLOSSOM TRL
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-7447
Mailing Address - Country:US
Mailing Address - Phone:317-863-2593
Mailing Address - Fax:317-863-2602
Practice Address - Street 1:522 BELVEDERE DR
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-5627
Practice Address - Country:US
Practice Address - Phone:765-453-4527
Practice Address - Fax:317-863-2602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004095A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1871574475OtherINDIVIDUAL NPI
IN231560Medicare PIN