=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629203542
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAVONNE JOHNSON LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/20/2009
-----------------------------------------------------
Last Update Date | 12/09/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2615 MEDICAL CENTER PARKWAY SUITE 1560
-----------------------------------------------------
City | MURFREESBORO
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37129-1702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-440-9952
-----------------------------------------------------
Fax | 855-531-0056
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1784 W NORTHFIELD BLVD # 363
-----------------------------------------------------
City | MURFREESBORO
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37129-1702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-440-9952
-----------------------------------------------------
Fax | 855-531-0056
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 1020
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------