Healthcare Provider Details

I. General information

NPI: 1578218178
Provider Name (Legal Business Name): MAYA JOHNSON MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2022
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2180 UNION AVE
MEMPHIS TN
38104-4205
US

IV. Provider business mailing address

4019 S GERMANTOWN RD
MEMPHIS TN
38125-2621
US

V. Phone/Fax

Practice location:
  • Phone: 901-300-9993
  • Fax:
Mailing address:
  • Phone: 901-878-5717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39005322A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401225035
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6853
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: