Individual
DR. KELLY CONNORS JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D., L.P.
Contact information
Practice address
159 MAIN ST, BELLEVILLE, MI 48111-2737
(734) 799-6047
Mailing address
PO BOX 1492, BELLEVILLE, MI 48112-1492
(734) 799-6047
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301013076
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0H27229
BLUE CROSS BLUE SHIELD OF MICHIGAN
MI
Enumeration date
10/03/2008
Last updated
04/16/2013
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