MEDICARE: CARRIE 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	101YM0800X	Mental Health Counselor	73839	TX

General Provider Information

NPI Number	:	1164139440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARRIE JOHNSON

Provider Business Mailing Address
First Line	:	8311 FAWN TERRACE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77071-3655
Country	:	US
Telephone Number	:	832-545-1906
Fax Number	:

Provider Business Practice Location Address
First Line	:	8311 FAWN TERRACE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77071-3655
Country	:	US
Telephone Number	:	832-545-1906
Fax Number	:

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

Provider Enumeration Date	:	11/04/2022
Last Update Date	:	11/04/2022

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Directions to “ CARRIE JOHNSON ” Practice Location

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