MEDICARE: BRENISHA 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1326753419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENISHA JOHNSON

Provider Business Mailing Address
First Line	:	1601 JACKSON ST
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71202-2029
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 JACKSON ST
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71202-2029
Country	:	US
Telephone Number	:	318-512-2857
Fax Number	:

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

Provider Enumeration Date	:	01/23/2023
Last Update Date	:	01/23/2023

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Directions to “ BRENISHA JOHNSON ” Practice Location

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