Healthcare Provider Details

I. General information

NPI: 1063321024
Provider Name (Legal Business Name): ROBERT LOUIS JOHNSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14431 N US19
LAMONT FL
32336-5043
US

IV. Provider business mailing address

14431 N US19
LAMONT FL
32336-5043
US

V. Phone/Fax

Practice location:
  • Phone: 850-948-7926
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH1426
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: