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NPI Code Detail

MEDICARE: OLIVIA GRACE JOHNSON

MEDICARE: OLIVIA GRACE 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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1598612707
Entity Type Code : Individual
Provider Name (Legal Business Name) : OLIVIA GRACE JOHNSON
Provider Business Mailing Address
First Line : 10000 N 31ST AVE STE C307
Second Line :
City : PHOENIX
State : AZ
Zip : 85051-9569
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 10000 N 31ST AVE STE C307
Second Line :
City : PHOENIX
State : AZ
Zip : 85051-9569
Country : US
Telephone Number : 480-651-4209
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2026
Last Update Date : 03/16/2026

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Directions to “ OLIVIA GRACE JOHNSON ” Practice Location

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