MEDICARE: KATHRYN JOHNSON L.L.P.C.

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	101YM0800X	Mental Health Counselor	6401015859	MI

General Provider Information

NPI Number	:	1124565056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN JOHNSON L.L.P.C.

Provider Business Mailing Address
First Line	:	555 TOWNER ST
Second Line	:
City	:	YPSILANTI
State	:	MI
Zip	:	48198-5752
Country	:	US
Telephone Number	:	734-544-3000
Fax Number	:	734-544-6732

Provider Business Practice Location Address
First Line	:	4282 N QUAIL CANYON DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85750-6917
Country	:	US
Telephone Number	:	520-612-0466
Fax Number	:

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

Provider Enumeration Date	:	01/30/2017
Last Update Date	:	04/04/2025

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