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Individual

MATTHEW TYLER JOHNSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LICSW

Contact information

Practice address
4820 77TH ST W STE 117, EDINA, MN 55435-4809
(612) 208-2762
Mailing address
800 PRAIRIE CENTER DR STE 210, EDEN PRAIRIE, MN 55344-7306
(612) 888-0544

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
27484
MN

Other

Enumeration date
07/20/2021
Last updated
01/16/2025
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