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NPI Code Detail

MEDICARE: MR. AMSALU HAROLD JOHNSON SR.

MEDICARE: MR. AMSALU HAROLD JOHNSON SR.
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1386029122
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. AMSALU HAROLD JOHNSON SR.
Provider Business Mailing Address
First Line : 1350 GRAN SUMMIT DR
Second Line :
City : RENO
State : NV
Zip : 89523-2563
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1350 GRAND SUMMIT DR
Second Line : APT 316
City : RENO
State : NV
Zip : 89523-2586
Country : US
Telephone Number : 775-217-1473
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2015
Last Update Date : 07/22/2015

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