MEDICARE: AMBER JOHNSON LPCC

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	CCMH0188241	NM

General Provider Information

NPI Number	:	1659701506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER JOHNSON LPCC

Provider Business Mailing Address
First Line	:	6962 GOLDEN MESA
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507-3457
Country	:	US
Telephone Number	:	505-718-4706
Fax Number	:

Provider Business Practice Location Address
First Line	:	6962 GOLDEN MESA
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507-3457
Country	:	US
Telephone Number	:	505-718-4706
Fax Number	:	505-569-6306

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

Provider Enumeration Date	:	11/13/2013
Last Update Date	:	09/26/2024

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