MEDICARE: JOSEPH MITCHELL JOHNSON SWLC

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	BBH-SWLC-LIC-81244	MT

General Provider Information

NPI Number	:	1831021286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH MITCHELL JOHNSON SWLC

Provider Business Mailing Address
First Line	:	819 W KOCH ST
Second Line	:
City	:	BOZEMAN
State	:	MT
Zip	:	59715-4434
Country	:	US
Telephone Number	:	406-451-5775
Fax Number	:

Provider Business Practice Location Address
First Line	:	2002 N 22ND AVE STE 1
Second Line	:
City	:	BOZEMAN
State	:	MT
Zip	:	59718-3153
Country	:	US
Telephone Number	:	406-579-4984
Fax Number	:

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

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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