Healthcare Provider Details

I. General information

NPI: 1417764721
Provider Name (Legal Business Name): JASON WAYNE JOHNSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2024
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 PARK PLACE DR
WASHINGTON PA
15301-2068
US

IV. Provider business mailing address

3000 PARK PLACE DR
WASHINGTON PA
15301-2068
US

V. Phone/Fax

Practice location:
  • Phone: 724-893-5430
  • Fax:
Mailing address:
  • Phone: 724-893-5430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC020484
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: