MEDICARE: COURTNEY JOHNSON LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical	55544	TX

General Provider Information

NPI Number	:	1023414562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY JOHNSON LCSW

Provider Business Mailing Address
First Line	:	3300 SAGE RD APT 3111
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77056-7062
Country	:	US
Telephone Number	:	231-557-5680
Fax Number	:

Provider Business Practice Location Address
First Line	:	3300 SAGE RD APT 3111
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77056-7062
Country	:	US
Telephone Number	:	231-557-5680
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/11/2014
Last Update Date	:	11/20/2014

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