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NPI Code Detail

MEDICARE: TANESHIA JOHNSON

MEDICARE: TANESHIA 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
1101YA0400XAddiction (Substance Use Disorder) CounselorA051020319CA
2101YA0400XAddiction (Substance Use Disorder) Counselor12849CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
112849OTHERCASUDCC
2A051020319OTHERCACCAPP

General Provider Information

NPI Number : 1265967947
Entity Type Code : Individual
Provider Name (Legal Business Name) : TANESHIA JOHNSON
Provider Business Mailing Address
First Line : PO BOX 3218
Second Line :
City : BAKERSFIELD
State : CA
Zip : 93385-3218
Country : US
Telephone Number : 661-325-1817
Fax Number : 661-325-3929
Provider Business Practice Location Address
First Line : 531 KNOTTS ST
Second Line :
City : BAKERSFIELD
State : CA
Zip : 93305-3043
Country : US
Telephone Number : 661-325-1817
Fax Number : 661-325-3929
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2017
Last Update Date : 05/24/2022

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Directions to “ TANESHIA JOHNSON ” Practice Location

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