MEDICARE: TIFFANY SHARESE JOHNSON ACSW

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	101Y00000X	Counselor
2	172V00000X	Community Health Worker
3	104100000X	Social Worker	120197	CA

General Provider Information

NPI Number	:	1740826304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY SHARESE JOHNSON ACSW

Provider Business Mailing Address
First Line	:	18818 OUTER HWY 18
Second Line	:
City	:	APPLE VALLEY
State	:	CA
Zip	:	92307-2323
Country	:	US
Telephone Number	:	760-995-8300
Fax Number	:

Provider Business Practice Location Address
First Line	:	11951 HESPERIA RD
Second Line	:
City	:	HESPERIA
State	:	CA
Zip	:	92345-1855
Country	:	US
Telephone Number	:	760-956-2345
Fax Number	:	760-956-3761

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

Provider Enumeration Date	:	11/19/2019
Last Update Date	:	01/13/2026

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