MEDICARE: TABITHA JOHNSON MFT, PLLC

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	251S00000X	Community/Behavioral Health Agency	01214	NV

General Provider Information

NPI Number	:	1164819157
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TABITHA JOHNSON MFT, PLLC

Provider Business Mailing Address
First Line	:	8565 S EASTERN AVE STE 172
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-2907
Country	:	US
Telephone Number	:	702-279-8200
Fax Number	:

Provider Business Practice Location Address
First Line	:	8565 S EASTERN AVE STE 172
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-2907
Country	:	US
Telephone Number	:	702-279-8200
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MS. TABITHA M. JOHNSON
Credential	:	LMFT
Telephone Number	:	702-279-8200

Provider Enumeration Date	:	04/17/2015
Last Update Date	:	04/17/2015

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