MEDICARE: MR. LEWIS JOHNSON LPC, NCC

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	PC017932	PA

General Provider Information

NPI Number	:	1720749369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LEWIS JOHNSON LPC, NCC

Provider Business Mailing Address
First Line	:	7408 W CHESTER PIKE
Second Line	:
City	:	UPPER DARBY
State	:	PA
Zip	:	19082-2006
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7408 W CHESTER PIKE
Second Line	:
City	:	UPPER DARBY
State	:	PA
Zip	:	19082-2006
Country	:	US
Telephone Number	:	267-209-0314
Fax Number	:

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

Provider Enumeration Date	:	01/05/2022
Last Update Date	:	12/12/2024

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