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General NPI Number Information
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NPI Number | 1811238587
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Entity Type | Individual
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Provider Name | MARK A JOHNSON SR. LCSW, LCDC
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Gender | Male
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Dates
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Enumeration Date | 03/06/2013
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Last Update Date | 12/15/2023
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Provider Practice Location Address
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Address Line | 6900 N PECOS RD
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89086-4400
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Country | US
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Telephone | 702-791-9000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 336685
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89033-6685
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Country | US
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Telephone | 702-524-0626
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 14357
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 60924
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 089.0134242
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License Number State | VT
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 97416
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License Number State | CA
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