MEDICARE: WILLIE EDWARD JOHNSON MSW, LCSW

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	1041C0700X	Clinical Social Worker	5530-C	NV
2	1041C0700X	Clinical Social Worker	6801062390	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255588216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIE EDWARD JOHNSON MSW, LCSW

Provider Business Mailing Address
First Line	:	9360 WARM WATERS AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-7865
Country	:	US
Telephone Number	:	702-421-3741
Fax Number	:

Provider Business Practice Location Address
First Line	:	7550 CONSTANTINOPLE AVE BLDG 2
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-6505
Country	:	US
Telephone Number	:	702-421-5563
Fax Number	:

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

Provider Enumeration Date	:	08/21/2008
Last Update Date	:	03/12/2009

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