MEDICARE: SHEMENA NASHEA JOHNSON MFT

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	106H00000X	Marriage & Family Therapist		CA
2	106H00000X	Marriage & Family Therapist	MFC53108	CA

General Provider Information

NPI Number	:	1578895298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEMENA NASHEA JOHNSON MFT

Provider Business Mailing Address
First Line	:	822 S ROBERTSON BLVD
Second Line	:	SUITE 303
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-1613
Country	:	US
Telephone Number	:	323-680-8162
Fax Number	:

Provider Business Practice Location Address
First Line	:	822 S ROBERTSON BLVD
Second Line	:	SUITE 303
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-1613
Country	:	US
Telephone Number	:	323-680-8162
Fax Number	:

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

Provider Enumeration Date	:	02/04/2010
Last Update Date	:	12/05/2016

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