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General NPI Number Information
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NPI Number | 1285924936
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Entity Type | Individual
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Provider Name | TABITHA JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 04/14/2011
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Last Update Date | 05/04/2017
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Provider Practice Location Address
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Address Line | 8565 S EASTERN AVE 172
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City | LAS VEGAS
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State | NV
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Zip | 89123-2808
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Country | US
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Telephone | 702-279-8200
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Fax |
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Provider Business Mailing Address
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Address Line | 8565 S EASTERN AVE 172
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City | LAS VEGAS
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State | NV
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Zip | 89123-2808
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Country | US
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Telephone | 702-279-8200
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 01214
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License Number State | NV
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