MEDICARE: MS. VIRGINIA STANGELAND JOHNSON MC

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	101YM0800X	Mental Health Counselor	60152895	WA
2	101YP2500X	Professional Counselor	60152895	WA

General Provider Information

NPI Number	:	1316254675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VIRGINIA STANGELAND JOHNSON MC

Provider Business Mailing Address
First Line	:	3504 SW WEBSTER ST
Second Line	:	#208
City	:	SEATTLE
State	:	WA
Zip	:	98126-3272
Country	:	US
Telephone Number	:	206-938-4643
Fax Number	:

Provider Business Practice Location Address
First Line	:	3504 SW WEBSTER ST
Second Line	:	#208
City	:	SEATTLE
State	:	WA
Zip	:	98126-3272
Country	:	US
Telephone Number	:	206-938-4643
Fax Number	:

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

Provider Enumeration Date	:	09/08/2010
Last Update Date	:	09/08/2010

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