Michelle Johnson
Individual provider Active NPI Health Service Psychologist · Hawthorne, FL
NPI 1962019935 · NPPES record last updated Sep 24, 2020
Key facts
- NPI
- 1962019935
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Health Service Psychologist 103TH0100X
- License
- 236912 (FL)
- Practice address
- 22513 SE 61St Ave
Hawthorne, FL 32640-3640 - Phone
- (352) 234-5738
- NPI assigned
- Sep 24, 2020
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 236912 | FL | MD | Health Service Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Harmony Fruition Agency LLC | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Health Service Psychologist | 103TH0100X | 236912 | FL | Yes |
Addresses
Primary practice location
22513 SE 61St Ave
Hawthorne, FL 32640-3640
Mailing address
22513 SE 61St Ave
Hawthorne, FL 32640-3640
Phone (352) 234-5738
Other providers in Hawthorne, FL
- Hawthorne Medical Center, Inc.
- Healthy Lifestyles, LLC
- Holiday CVS LLC
- Katherine Sue Hooper
- Nikki Nicole Hutchinson
- Jra Health, LLC
- Lorraine N Keites
- Elizabeth Landrus
- Neil Franklin Letts
- Gillian Louissaint
All providers in Hawthorne, FL · Health Service Psychologist in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 24, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.