MEDICARE: MR. WILLIAM JOHNSON JR. M.S.

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1144613324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM JOHNSON JR. M.S.

Provider Business Mailing Address
First Line	:	4014 CYPRESS CT
Second Line	:
City	:	COUNTRY CLUB HILLS
State	:	IL
Zip	:	60478-5752
Country	:	US
Telephone Number	:	708-365-6721
Fax Number	:

Provider Business Practice Location Address
First Line	:	4014 CYPRESS CT
Second Line	:
City	:	COUNTRY CLUB HILLS
State	:	IL
Zip	:	60478-5752
Country	:	US
Telephone Number	:	708-365-6721
Fax Number	:

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

Provider Enumeration Date	:	03/11/2015
Last Update Date	:	03/11/2015

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