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NPI Code Detail

MEDICARE: DR. MICHAEL PHILLIP JOHNSON PHD

MEDICARE: DR. MICHAEL PHILLIP JOHNSON PHD
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
1101YM0800XMental Health CounselorLCS742CA

General Provider Information

NPI Number : 1225184021
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL PHILLIP JOHNSON PHD
Provider Business Mailing Address
First Line : 2432 CASCADE TRL
Second Line :
City : COOL
State : CA
Zip : 95614-2603
Country : US
Telephone Number : 530-887-1846
Fax Number :
Provider Business Practice Location Address
First Line : 11670 ATWOOD RD
Second Line :
City : AUBURN
State : CA
Zip : 95603-9522
Country : US
Telephone Number : 530-887-2828
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2007
Last Update Date : 07/08/2007

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