MEDICARE: NATALIE 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	101YA0400X	Addiction (Substance Use Disorder) Counselor		NV

General Provider Information

NPI Number	:	1457833980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALIE JOHNSON

Provider Business Mailing Address
First Line	:	3376 S EASTERN AVE STE 150
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-3367
Country	:	US
Telephone Number	:	702-538-7412
Fax Number	:	702-538-7418

Provider Business Practice Location Address
First Line	:	2887 S MARYLAND PKWY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-1511
Country	:	US
Telephone Number	:	702-474-4104
Fax Number	:	702-474-4108

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

Provider Enumeration Date	:	08/31/2018
Last Update Date	:	01/13/2025

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Directions to “ NATALIE JOHNSON ” Practice Location

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