MEDICARE: PEGGY M JOHNSON LPC-C

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		OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588936199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEGGY M JOHNSON LPC-C

Provider Business Mailing Address
First Line	:	PO BOX 702504
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74170-2504
Country	:	US
Telephone Number	:	918-791-0026
Fax Number	:	918-791-0043

Provider Business Practice Location Address
First Line	:	4122 W 55TH PL STE 119
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74107-9108
Country	:	US
Telephone Number	:	918-791-0026
Fax Number	:	918-791-0043

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

Provider Enumeration Date	:	01/30/2012
Last Update Date	:	03/05/2015

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Directions to “ PEGGY M JOHNSON LPC-C” Practice Location

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