MEDICARE: CYNTHIA LEE JOHNSON LMHP

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	1554	NE

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	:	1477507358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA LEE JOHNSON LMHP

Provider Business Mailing Address
First Line	:	11330 Q ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68137-3679
Country	:	US
Telephone Number	:	402-616-4411
Fax Number	:	402-597-2349

Provider Business Practice Location Address
First Line	:	11330 Q ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68137-3679
Country	:	US
Telephone Number	:	402-616-4411
Fax Number	:	402-597-2349

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

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	07/08/2007

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