MEDICARE: MRS. TAMMI J JOHNSON LMFT, LCADC

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	0859	NV

General Provider Information

NPI Number	:	1558571638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TAMMI J JOHNSON LMFT, LCADC

Provider Business Mailing Address
First Line	:	6112 RIDGECARN AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-1372
Country	:	US
Telephone Number	:	702-561-5605
Fax Number	:

Provider Business Practice Location Address
First Line	:	2441 TECH CENTER CT STE 102
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0804
Country	:	US
Telephone Number	:	702-518-8061
Fax Number	:	702-946-5083

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

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	03/22/2019

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