MEDICARE: SIMONA S 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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1235008012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIMONA S JOHNSON

Provider Business Mailing Address
First Line	:	5912 KANE HOLLY STREET
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89031-1767
Country	:	US
Telephone Number	:	619-250-2530
Fax Number	:

Provider Business Practice Location Address
First Line	:	5912 KANE HOLLY ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-4950
Country	:	US
Telephone Number	:	619-250-2530
Fax Number	:

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

Provider Enumeration Date	:	10/31/2025
Last Update Date	:	10/31/2025

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Directions to “ SIMONA S JOHNSON ” Practice Location

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