MEDICARE: DAVID W JOHNSON MFC

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	106H00000X	Marriage & Family Therapist	MFC35499	CA
2	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1508063694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID W JOHNSON MFC

Provider Business Mailing Address
First Line	:	32197 MEADOW RIDGE RD
Second Line	:
City	:	COARSEGOLD
State	:	CA
Zip	:	93614-9559
Country	:	US
Telephone Number	:	559-642-2987
Fax Number	:

Provider Business Practice Location Address
First Line	:	3097 WILLOW AVE STE 4
Second Line	:
City	:	CLOVIS
State	:	CA
Zip	:	93612-4715
Country	:	US
Telephone Number	:	559-707-9212
Fax Number	:

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

Provider Enumeration Date	:	07/02/2007
Last Update Date	:	11/07/2022

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