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NPI Code Detail

MEDICARE: MEGAN JOHNSON LCSW, CAC III

MEDICARE: MEGAN JOHNSON LCSW, CAC III
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
1101YA0400XAddiction (Substance Use Disorder) CounselorACC.0006368CO
21041C0700XClinical Social WorkerCSW.09923648CO

General Provider Information

NPI Number : 1104252329
Entity Type Code : Individual
Provider Name (Legal Business Name) : MEGAN JOHNSON LCSW, CAC III
Provider Business Mailing Address
First Line : 125 CRESTRIDGE ST
Second Line :
City : FORT COLLINS
State : CO
Zip : 80525-3934
Country : US
Telephone Number : 970-494-9761
Fax Number : 970-300-3120
Provider Business Practice Location Address
First Line : 125 CRESTRIDGE ST
Second Line :
City : FORT COLLINS
State : CO
Zip : 80525-3934
Country : US
Telephone Number : 970-494-9761
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/19/2013
Last Update Date : 12/09/2014

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