MEDICARE: MS. CHRISTIE FAYE 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	101YS0200X	School Counselor	T081343089	OK
2	103K00000X	Behavior Analyst
3	171M00000X	Case Manager/Care Coordinator
4	101YM0800X	Mental Health Counselor	CI5608	NV

General Provider Information

NPI Number	:	1548575681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHRISTIE FAYE JOHNSON

Provider Business Mailing Address
First Line	:	3430 E RUSSELL RD STE 315
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-2201
Country	:	US
Telephone Number	:	702-527-8351
Fax Number	:

Provider Business Practice Location Address
First Line	:	3430 E RUSSELL RD STE 315
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-2201
Country	:	US
Telephone Number	:	702-527-8351
Fax Number	:

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

Provider Enumeration Date	:	08/13/2010
Last Update Date	:	08/24/2025

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