MEDICARE: FRANCES TARESSA 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	106S00000X	Behavior Technician		AZ

General Provider Information

NPI Number	:	1578276903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FRANCES TARESSA JOHNSON

Provider Business Mailing Address
First Line	:	6036 S 3RD AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85041-5706
Country	:	US
Telephone Number	:	240-784-6530
Fax Number	:

Provider Business Practice Location Address
First Line	:	6036 S 3RD AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85041-5706
Country	:	US
Telephone Number	:	240-784-6530
Fax Number	:

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

Provider Enumeration Date	:	12/30/2022
Last Update Date	:	12/30/2022

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Directions to “ FRANCES TARESSA JOHNSON ” Practice Location

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