Healthcare Provider Details

I. General information

NPI: 1598043903
Provider Name (Legal Business Name): TAYLOR JOHNSON M.A., L.P.C., M.DIV.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2011
Last Update Date: 08/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11695 S BLACKBOB RD
OLATHE KS
66062-1058
US

IV. Provider business mailing address

11695 S BLACKBOB RD
OLATHE KS
66062-1058
US

V. Phone/Fax

Practice location:
  • Phone: 913-768-6606
  • Fax: 913-768-6609
Mailing address:
  • Phone: 913-768-6606
  • Fax: 913-768-6609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberT-LPC2281
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License NumberT-LPC2281
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberT-LPC2281
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: