Healthcare Provider Details

I. General information

NPI: 1790438182
Provider Name (Legal Business Name): MS. JOHANN T JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2022
Last Update Date: 01/27/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3205 NEW HIGHWAY 51 STE C
LA PLACE LA
70068-6512
US

IV. Provider business mailing address

3205 NEW HIGHWAY 51 STE C
LA PLACE LA
70068-6512
US

V. Phone/Fax

Practice location:
  • Phone: 985-652-1809
  • Fax: 985-652-1808
Mailing address:
  • Phone: 985-652-1809
  • Fax: 985-652-1808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: