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NPI Code Detail

MEDICARE: NELLY JOHNSON

MEDICARE: NELLY 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
1106H00000XMarriage & Family TherapistIMF788485CA

General Provider Information

NPI Number : 1174946560
Entity Type Code : Individual
Provider Name (Legal Business Name) : NELLY JOHNSON
Provider Business Mailing Address
First Line : 602 COMMERCE AVE STE E
Second Line :
City : PALMDALE
State : CA
Zip : 93551-3882
Country : US
Telephone Number : 661-810-3671
Fax Number :
Provider Business Practice Location Address
First Line : 21125 CENTRE POINTE PKWY
Second Line :
City : SANTA CLARITA
State : CA
Zip : 91350-2994
Country : US
Telephone Number : 554-353-8018
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/21/2014
Last Update Date : 10/22/2021

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