Healthcare Provider Details

I. General information

NPI: 1548575681
Provider Name (Legal Business Name): MS. CHRISTIE FAYE JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2010
Last Update Date: 08/24/2025
Certification Date: 08/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3430 E RUSSELL RD STE 315
LAS VEGAS NV
89120-2201
US

IV. Provider business mailing address

3430 E RUSSELL RD STE 315
LAS VEGAS NV
89120-2201
US

V. Phone/Fax

Practice location:
  • Phone: 702-527-8351
  • Fax:
Mailing address:
  • Phone: 702-527-8351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License NumberT081343089
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCI5608
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: