Melita Travis Johnson, LMSW, CCDP

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6801063274 Issued in MI

Practice address

770 Kenmoor Ave SE Ste 103
Grand Rapids, MI 49546-8602

Phone

(616) 481-9337

Fax

(616) 719-3119

NPI assigned

Mar 18, 2015

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Melita Travis Johnson, LMSW, CCDP

  • Community/Behavioral Health Agency
  • Grand Rapids, MI
  • NPI 1417355322
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1426636800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1426636800000",
    "number": "1376936104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1130 ELMDALE ST NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495252632",
            "telephone_number": "616-481-9337",
            "fax_number": "616-719-3119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "770 KENMOOR AVE SE STE 103",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495468602",
            "telephone_number": "616-481-9337",
            "fax_number": "616-719-3119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRAVIS JOHNSON",
        "first_name": "MELITA",
        "name_prefix": "Ms.",
        "credential": "LMSW, CCDP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-03-18",
        "last_updated": "2015-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801063274",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Transition Pathways,Inc
• Andra Trapp, DDS
• Aimee Travers, MD
• Stephen Christopher Travilla
• Maggie Mae Travin, LPC. LLP
• Ayden Helene Travis
• Catera Kemyatta Travis
• Clair Anne Travis, PAC
• Lisa Jean Travis
• Marc Travis, MD

• Clinical Social Worker in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.