Individual
MICHAEL BLAINE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
416 COLLEGE ST, BELOIT, WI 53511-6310
(608) 365-1244
(608) 365-4097
Mailing address
1822 CLEVELAND ST, BELOIT, WI 53511-2848
(608) 436-9182
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
3648-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42117900
—
WI
Enumeration date
07/28/2018
Last updated
07/28/2018
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