MEDICARE: SHANELLE D. JOHNSON LMFT

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	106H00000X	Marriage & Family Therapist	105060	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	414012219	OTHER	CA	CROWNJOHNSONCONSULTING
2	384104888	OTHER	CA	URBANRESTORATIONCOUNSELINGCENTER

General Provider Information

NPI Number	:	1417372442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANELLE D. JOHNSON LMFT

Provider Business Mailing Address
First Line	:	1925 EUCLID AVE STE 108
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92105-5362
Country	:	US
Telephone Number	:	619-648-1158
Fax Number	:	619-303-0449

Provider Business Practice Location Address
First Line	:	1925 EUCLID AVE STE 108
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92105-5362
Country	:	US
Telephone Number	:	619-648-1158
Fax Number	:	619-303-0049

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

Provider Enumeration Date	:	02/27/2014
Last Update Date	:	02/27/2026

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Directions to “ SHANELLE D. JOHNSON LMFT” Practice Location

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