MEDICARE: EARL 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	106H00000X	Marriage & Family Therapist	302665	KY

General Provider Information

NPI Number	:	1225995509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EARL JOHNSON

Provider Business Mailing Address
First Line	:	3613 LEISURE CREEK CT
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40517-2902
Country	:	US
Telephone Number	:	859-309-2877
Fax Number	:

Provider Business Practice Location Address
First Line	:	80 CODELL DR STE 230
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-1178
Country	:	US
Telephone Number	:	859-309-2877
Fax Number	:

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

Provider Enumeration Date	:	01/07/2026
Last Update Date	:	01/07/2026

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Directions to “ EARL JOHNSON ” Practice Location

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