MEDICARE: MS. JOYCE 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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1356625743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JOYCE JOHNSON

Provider Business Mailing Address
First Line	:	4122 BONITA DESERT CT
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-3471
Country	:	US
Telephone Number	:	702-326-8851
Fax Number	:

Provider Business Practice Location Address
First Line	:	3785 E SUNSET RD
Second Line	:	SUITE A-10
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-6259
Country	:	US
Telephone Number	:	702-985-2345
Fax Number	:

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

Provider Enumeration Date	:	10/04/2011
Last Update Date	:	10/04/2011

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