MEDICARE: LEIGH TEAGUE 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	117551	CA

General Provider Information

NPI Number	:	1467083048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEIGH TEAGUE JOHNSON

Provider Business Mailing Address
First Line	:	1614 X ST
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95818-2300
Country	:	US
Telephone Number	:	916-287-3305
Fax Number	:

Provider Business Practice Location Address
First Line	:	1614 X ST
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95818-2300
Country	:	US
Telephone Number	:	916-287-3305
Fax Number	:

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

Provider Enumeration Date	:	01/31/2020
Last Update Date	:	01/31/2020

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Directions to “ LEIGH TEAGUE JOHNSON ” Practice Location

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