Melita Travis Johnson, LMSW, CCDP

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

6801063274 Issued in MI

Legal business name

MELITA TRAVIS JOHNSON, LMSW, CCDP

Practice address

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

Phone

(616) 481-9337

Fax

(616) 719-3119

NPI assigned

Dec 9, 2014

Organization subpart

No

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

Authorized official

Name

Ms. Melita Travis Johnson, LMSW, CCDPNPI 1376936104

Title

Therapist Consultant

Phone

(616) 481-9337

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Melita Travis Johnson, LMSW, CCDP

  • Clinical Social Worker
  • Grand Rapids, MI
  • NPI 1376936104
  NPD (past) Authorized official

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

{
    "created_epoch": "1418083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418083200000",
    "number": "1417355322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1130 ELMDALE AVE 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": {
        "organization_name": "MELITA TRAVIS JOHNSON, LMSW, CCDP",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-09",
        "last_updated": "2014-12-09",
        "status": "A",
        "authorized_official_last_name": "TRAVIS JOHNSON",
        "authorized_official_first_name": "MELITA",
        "authorized_official_title_or_position": "THERAPIST CONSULTANT",
        "authorized_official_telephone_number": "616-481-9337",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LMSW, CCDP"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MI",
            "license": "6801063274",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa a Sandman MD PC
• Melissa Deniel PLC
• Melissa Jeanne Vanderzyden
• Melissa Muir Counseling Services PLLC (Forest Hills Therapy, PLLC)
• Melissa R Tower
• Nadine Melnedez
• Hannah Melnik
• Marianne K Melnik, MD
• Natalie Meloche
• Alexandria Melton

• Community/Behavioral Health Agency in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Community/Behavioral Health Agency in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2014; 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.