MEDICARE: MRS. ANDREA N. JOHNSON LCPC

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	101YP2500X	Professional Counselor		IL
2	222Q00000X	Developmental Therapist		IL

General Provider Information

NPI Number	:	1568493336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANDREA N. JOHNSON LCPC

Provider Business Mailing Address
First Line	:	3270 MOORE RD
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62707-2515
Country	:	US
Telephone Number	:	217-793-0509
Fax Number	:	217-793-0509

Provider Business Practice Location Address
First Line	:	3270 MOORE RD
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62707-2515
Country	:	US
Telephone Number	:	217-899-3217
Fax Number	:	217-793-0509

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

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	09/11/2025

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