MEDICARE: TAYLOR JOHNSON LPC-MHSP

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	6921	TN

General Provider Information

NPI Number	:	1134943830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR JOHNSON LPC-MHSP

Provider Business Mailing Address
First Line	:	5496 LYFORD AVE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38119-6968
Country	:	US
Telephone Number	:	901-517-8038
Fax Number	:

Provider Business Practice Location Address
First Line	:	5496 LYFORD AVE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38119-6968
Country	:	US
Telephone Number	:	901-517-8038
Fax Number	:

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

Provider Enumeration Date	:	11/11/2024
Last Update Date	:	11/11/2024

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