MEDICARE: DASIA 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	103K00000X	Behavior Analyst	Z13723206	MO
2	101Y00000X	Counselor
3	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1457856338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DASIA JOHNSON

Provider Business Mailing Address
First Line	:	1430 OLIVE ST STE 400
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63103-2303
Country	:	US
Telephone Number	:	314-517-8602
Fax Number	:

Provider Business Practice Location Address
First Line	:	1150 GRAHAM RD STE 101
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63031-8077
Country	:	US
Telephone Number	:	314-206-3900
Fax Number	:

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

Provider Enumeration Date	:	03/24/2018
Last Update Date	:	02/04/2026

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Directions to “ DASIA JOHNSON ” Practice Location

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