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NPI Code Detail

MEDICARE: JAMAL HUSSEIN JOHNSON CATC-IV

MEDICARE: JAMAL HUSSEIN JOHNSON CATC-IV
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
1101YA0400XAddiction (Substance Use Disorder) Counselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1548683444
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMAL HUSSEIN JOHNSON CATC-IV
Provider Business Mailing Address
First Line : 835 HIGHLAND SPRINGS AVE STE 210
Second Line :
City : BEAUMONT
State : CA
Zip : 92223-5771
Country : US
Telephone Number : 951-956-7827
Fax Number :
Provider Business Practice Location Address
First Line : 840 N AVENUE 66
Second Line :
City : LOS ANGELES
State : CA
Zip : 90042-1508
Country : US
Telephone Number : 951-956-7827
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/28/2014
Last Update Date : 12/11/2025

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