MEDICARE: CHARNISE PATRICE SCOTT JOHNSON 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
1	101YP2500X	Professional Counselor	9709	LA

General Provider Information

NPI Number	:	1528762861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARNISE PATRICE SCOTT JOHNSON LPC

Provider Business Mailing Address
First Line	:	2924 KNIGHT ST
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71105-2415
Country	:	US
Telephone Number	:	318-210-0587
Fax Number	:

Provider Business Practice Location Address
First Line	:	2924 KNIGHT ST
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71105-2415
Country	:	US
Telephone Number	:	318-210-0587
Fax Number	:

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

Provider Enumeration Date	:	03/29/2023
Last Update Date	:	05/26/2026

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