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NPI Code Detail

MEDICARE: MR. KAVIN WOOD JOHNSON M.S., L.P.C.

MEDICARE: MR. KAVIN WOOD JOHNSON M.S., L.P.C.
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
1101YP2500XProfessional Counselor12688TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
183282LOTHERTXBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1780738195
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KAVIN WOOD JOHNSON M.S., L.P.C.
Provider Business Mailing Address
First Line : 1530 S MONROE ST
Second Line :
City : SAN ANGELO
State : TX
Zip : 76901-4424
Country : US
Telephone Number : 325-656-1678
Fax Number :
Provider Business Practice Location Address
First Line : 36 E TWOHIG AVE
Second Line : STE. 300
City : SAN ANGELO
State : TX
Zip : 76903-6433
Country : US
Telephone Number : 325-656-1678
Fax Number : 325-949-3594
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/22/2007
Last Update Date : 01/11/2008

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