MEDICARE: DR. VIRGINIA JOHNSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	PSY23518	CA
2	103G00000X	Clinical Neuropsychologist	PSY23518	CA
3	103T00000X	Psychologist	PSY23518	CA
4	103TA0400X	Addiction (Substance Use Disorder) Psychologist	PSY23518	CA
5	103TA0700X	Adult Development & Aging Psychologist	PSY23518	CA
6	103TB0200X	Cognitive & Behavioral Psychologist	PSY23518	CA
7	103TC0700X	Clinical Psychologist	PSY23518	CA
8	103TC1900X	Counseling Psychologist	PSY23518	CA
9	103TC2200X	Clinical Child & Adolescent Psychologist	PSY23518	CA
10	103TF0000X	Family Psychologist	PSY23518	CA
11	103TF0200X	Forensic Psychologist	PSY23518	CA

General Provider Information

NPI Number	:	1124322797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIRGINIA JOHNSON

Provider Business Mailing Address
First Line	:	516 W SHAW AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93704-2515
Country	:	US
Telephone Number	:	559-221-4948
Fax Number	:

Provider Business Practice Location Address
First Line	:	516 W SHAW AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93704-2515
Country	:	US
Telephone Number	:	559-221-4948
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2010
Last Update Date	:	12/22/2010

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Directions to “ DR. VIRGINIA JOHNSON ” Practice Location

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