MEDICARE: DAVID JOHNSON LMHC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	CAP 3095	FL
2	101YM0800X	Mental Health Counselor	MH 9197	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CAP 3095	OTHER	FL	CAP
2	MH9197	OTHER	FL	LMHC

General Provider Information

NPI Number	:	1396978003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID JOHNSON LMHC

Provider Business Mailing Address
First Line	:	1861 S PATRICK DR
Second Line	:	BOX 166
City	:	INDIAN HARBOUR BEACH
State	:	FL
Zip	:	32937-4377
Country	:	US
Telephone Number	:	321-693-4573
Fax Number	:	321-610-8880

Provider Business Practice Location Address
First Line	:	1861 S PATRICK DR
Second Line	:	BOX 166
City	:	INDIAN HARBOUR BEACH
State	:	FL
Zip	:	32937-4377
Country	:	US
Telephone Number	:	321-693-4573
Fax Number	:	321-610-8880

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

Provider Enumeration Date	:	08/27/2009
Last Update Date	:	08/27/2009

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Directions to “ DAVID JOHNSON LMHC” Practice Location

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