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NPI Code Detail

MEDICARE: TANYA REA JOHNSON MS, LPC

MEDICARE: TANYA REA JOHNSON MS, LPC
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
1101YP2500XProfessional Counselor2017009491MO

General Provider Information

NPI Number : 1396144051
Entity Type Code : Individual
Provider Name (Legal Business Name) : TANYA REA JOHNSON MS, LPC
Provider Business Mailing Address
First Line : 1300 E BRADFORD PKWY
Second Line :
City : SPRINGFIELD
State : MO
Zip : 65804-4264
Country : US
Telephone Number : 417-761-5000
Fax Number :
Provider Business Practice Location Address
First Line : 323 E GRAND ST
Second Line :
City : SPRINGFIELD
State : MO
Zip : 65807-1447
Country : US
Telephone Number : 417-848-1417
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2014
Last Update Date : 03/16/2026

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