Individual
MATTHEW A JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
T-LMHC
Contact information
Practice address
1441 W CENTRAL PARK AVE, DAVENPORT, IA 52804-1707
(563) 383-1900
(563) 328-5690
Mailing address
1441 W CENTRAL PARK AVE, DAVENPORT, IA 52804-1707
(563) 383-1900
(563) 328-5690
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
095655
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
095655
LICENSE NUMBER
IA
Enumeration date
05/27/2021
Last updated
05/27/2021
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