MEDICARE: WILLIAM JOHNSON

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	390200000X	Student in an Organized Health Care Education/Training Program
2	106H00000X	Marriage & Family Therapist	126921	CA
3	106H00000X	Marriage & Family Therapist	IMF100748	CA

General Provider Information

NPI Number	:	1881071140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM JOHNSON

Provider Business Mailing Address
First Line	:	PO BOX 821
Second Line	:
City	:	WEST COVINA
State	:	CA
Zip	:	91793-0821
Country	:	US
Telephone Number	:	626-221-9650
Fax Number	:

Provider Business Practice Location Address
First Line	:	7080 HOLLYWOOD BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-6906
Country	:	US
Telephone Number	:	626-739-0265
Fax Number	:

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

Provider Enumeration Date	:	05/06/2015
Last Update Date	:	07/29/2022

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