=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982514626
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TARA JOHNSON LMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2026
-----------------------------------------------------
Last Update Date | 09/08/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17111 G DR N
-----------------------------------------------------
City | MARSHALL
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49068-9621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-781-1250
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3266 NIGHTHAWK LN
-----------------------------------------------------
City | BATTLE CREEK
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49015-7640
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-753-9085
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041S0200X
-----------------------------------------------------
Taxonomy Name | School Social Worker
-----------------------------------------------------
License Number | 6801085174
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 6801085174
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------