MEDICARE: PAUL JOHNSON SR. 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	CC3655	ME

General Provider Information

NPI Number	:	1578932711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL JOHNSON SR. LCPC

Provider Business Mailing Address
First Line	:	147 ACADEMY ST
Second Line	:	P.O. BOX 509
City	:	PRESQUE ISLE
State	:	ME
Zip	:	04769-3101
Country	:	US
Telephone Number	:	207-764-6825
Fax Number	:

Provider Business Practice Location Address
First Line	:	147 ACADEMY ST
Second Line	:
City	:	PRESQUE ISLE
State	:	ME
Zip	:	04769-3101
Country	:	US
Telephone Number	:	207-764-6825
Fax Number	:

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

Provider Enumeration Date	:	09/17/2015
Last Update Date	:	01/18/2026

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