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NPI Code Detail

MEDICARE: TRAEVONN JOHNSON MA

MEDICARE: TRAEVONN JOHNSON MA
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
1106H00000XMarriage & Family TherapistLMFT107431CA
2106H00000XMarriage & Family TherapistIMF91552CA

General Provider Information

NPI Number : 1740312651
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRAEVONN JOHNSON MA
Provider Business Mailing Address
First Line : 3200 MOTOR AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90034-3740
Country : US
Telephone Number : 310-836-1223
Fax Number :
Provider Business Practice Location Address
First Line : 3200 MOTOR AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90034-3740
Country : US
Telephone Number : 310-836-1223
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2007
Last Update Date : 11/27/2018

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Directions to “ TRAEVONN JOHNSON MA” Practice Location

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