MEDICARE: AMY JOHNSON LMFTA

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	106H00000X	Marriage & Family Therapist	MG61606691	WA

General Provider Information

NPI Number	:	1669335683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY JOHNSON LMFTA

Provider Business Mailing Address
First Line	:	210 POLK ST STE 2
Second Line	:
City	:	PORT TOWNSEND
State	:	WA
Zip	:	98368-6739
Country	:	US
Telephone Number	:	360-505-7924
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 POLK ST STE 2
Second Line	:
City	:	PORT TOWNSEND
State	:	WA
Zip	:	98368-6739
Country	:	US
Telephone Number	:	360-505-7924
Fax Number	:

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

Provider Enumeration Date	:	12/05/2025
Last Update Date	:	12/05/2025

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