MEDICARE: ALISON MARIE JOHNSON LCSW

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	1041C0700X	Clinical Social Worker	103828	TX

General Provider Information

NPI Number	:	1740053040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISON MARIE JOHNSON LCSW

Provider Business Mailing Address
First Line	:	2237 6TH AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76110-1807
Country	:	US
Telephone Number	:	682-365-7721
Fax Number	:

Provider Business Practice Location Address
First Line	:	3244 S ADAMS ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76110-6747
Country	:	US
Telephone Number	:	682-365-7721
Fax Number	:

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

Provider Enumeration Date	:	10/30/2023
Last Update Date	:	10/30/2023

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