MEDICARE: VENORA D JOHNSON MA, 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	77174	TX

General Provider Information

NPI Number	:	1215408307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VENORA D JOHNSON MA, LPC

Provider Business Mailing Address
First Line	:	6705 MATTNEY CIR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75237-2454
Country	:	US
Telephone Number	:	214-402-1018
Fax Number	:

Provider Business Practice Location Address
First Line	:	6705 MATTNEY CIR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75237-2454
Country	:	US
Telephone Number	:	469-554-9890
Fax Number	:

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

Provider Enumeration Date	:	12/16/2018
Last Update Date	:	10/18/2021

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