Healthcare Provider Details

I. General information

NPI: 1760734016
Provider Name (Legal Business Name): JOHN PHILLIP LAWSON L.M.F.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2012
Last Update Date: 03/13/2020
Certification Date: 03/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 E MOUNTCASTLE DR STE 1
JOHNSON CITY TN
37601-2509
US

IV. Provider business mailing address

2 REDBUSH CT #2
JOHNSON CITY TN
37601-4340
US

V. Phone/Fax

Practice location:
  • Phone: 423-283-4958
  • Fax: 423-283-7135
Mailing address:
  • Phone: 423-283-4958
  • Fax: 423-283-7135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number949
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: