Provider Demographics
NPI:1992599989
Name:MOLINA, JOHNNY LEE
Entity type:Individual
Prefix:
First Name:JOHNNY
Middle Name:LEE
Last Name:MOLINA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 N UNION ST APT 4
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:MI
Mailing Address - Zip Code:48847-1352
Mailing Address - Country:US
Mailing Address - Phone:989-436-2195
Mailing Address - Fax:
Practice Address - Street 1:216 N UNION ST APT 4
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:MI
Practice Address - Zip Code:48847-1352
Practice Address - Country:US
Practice Address - Phone:989-436-2195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst