MEDICARE: PORSCHIA JOHNSON LCPC

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	178013573	IL
2	101YP2500X	Professional Counselor	180013557	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	180013557	OTHER	IL	LCPC

General Provider Information

NPI Number	:	1558877688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PORSCHIA JOHNSON LCPC

Provider Business Mailing Address
First Line	:	6245 RUFE SNOW DR STE 2801008
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76148-3349
Country	:	US
Telephone Number	:	224-432-0175
Fax Number	:

Provider Business Practice Location Address
First Line	:	6245 RUFE SNOW DR STE 2801008
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76148-3349
Country	:	US
Telephone Number	:	224-432-0175
Fax Number	:

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

Provider Enumeration Date	:	12/27/2017
Last Update Date	:	12/04/2022

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Directions to “ PORSCHIA JOHNSON LCPC” Practice Location

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