MEDICARE: LATISHA JOHNSON LPC

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	101YP2500X	Professional Counselor	P1412110	AR

General Provider Information

NPI Number	:	1134408636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATISHA JOHNSON LPC

Provider Business Mailing Address
First Line	:	PO BOX 497
Second Line	:
City	:	AUGUSTA
State	:	AR
Zip	:	72006-0497
Country	:	US
Telephone Number	:	870-347-3475
Fax Number	:

Provider Business Practice Location Address
First Line	:	3150 E HERITAGE PKWY
Second Line	:
City	:	FARMINGTON
State	:	AR
Zip	:	72730-5529
Country	:	US
Telephone Number	:	479-400-1140
Fax Number	:	479-400-1151

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

Provider Enumeration Date	:	08/15/2011
Last Update Date	:	01/05/2024

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Directions to “ LATISHA JOHNSON LPC” Practice Location

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