Healthcare Provider Details

I. General information

NPI: 1962390278
Provider Name (Legal Business Name): LAMAR TYLER JOHNSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2025
Last Update Date: 07/13/2025
Certification Date: 07/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 DEKALB ST
NORRISTOWN PA
19401-3847
US

IV. Provider business mailing address

1033 DEKALB ST
NORRISTOWN PA
19401-3847
US

V. Phone/Fax

Practice location:
  • Phone: 267-298-7707
  • Fax:
Mailing address:
  • Phone: 267-298-7707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: