MEDICARE: TYRONE 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	101YM0800X	Mental Health Counselor	8176-226	WI

General Provider Information

NPI Number	:	1588486070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYRONE JOHNSON

Provider Business Mailing Address
First Line	:	6737 W WASHINGTON ST STE 2275
Second Line	:
City	:	WEST ALLIS
State	:	WI
Zip	:	53214-5666
Country	:	US
Telephone Number	:	414-246-2300
Fax Number	:

Provider Business Practice Location Address
First Line	:	3872 N 8TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53206-3303
Country	:	US
Telephone Number	:	414-252-0210
Fax Number	:

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

Provider Enumeration Date	:	10/28/2024
Last Update Date	:	10/28/2024

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Directions to “ TYRONE JOHNSON ” Practice Location

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