MEDICARE: MONIQUE C. JOHNSON

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 Social Worker	65885	TX

General Provider Information

NPI Number	:	1154067072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONIQUE C. JOHNSON

Provider Business Mailing Address
First Line	:	3433 W DALLAS ST APT 1056
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77019-3838
Country	:	US
Telephone Number	:	713-679-9431
Fax Number	:

Provider Business Practice Location Address
First Line	:	3433 W DALLAS ST APT 1056
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77019-3838
Country	:	US
Telephone Number	:	713-679-9434
Fax Number	:

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

Provider Enumeration Date	:	05/12/2022
Last Update Date	:	05/12/2022

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Directions to “ MONIQUE C. JOHNSON ” Practice Location

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