MEDICARE: MR. TEDDY RAY JOHNSTON M.A.

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	MFC45207	CA

General Provider Information

NPI Number	:	1477671196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TEDDY RAY JOHNSTON M.A.

Provider Business Mailing Address
First Line	:	4781 E GETTYSBURG AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93726-1814
Country	:	US
Telephone Number	:	559-304-0514
Fax Number	:

Provider Business Practice Location Address
First Line	:	4781 E GETTYSBURG AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93726-1814
Country	:	US
Telephone Number	:	559-304-0514
Fax Number	:

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

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	02/11/2022

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