MEDICARE: MS. MARY CATHERINE JOHNS LMSW CACT LMFT

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	CACI100774	MI
2	1041C0700X	Clinical Social Worker	LMSW6801002990	MI
3	106H00000X	Marriage & Family Therapist	LMFT4101005140	MI

General Provider Information

NPI Number	:	1689719593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY CATHERINE JOHNS LMSW CACT LMFT

Provider Business Mailing Address
First Line	:	23909 EDWARD
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48128-1223
Country	:	US
Telephone Number	:	313-563-3407
Fax Number	:	313-563-7415

Provider Business Practice Location Address
First Line	:	23909 EDWARD
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48128-1223
Country	:	US
Telephone Number	:	313-563-3407
Fax Number	:	313-563-7415

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

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	09/11/2025

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