MEDICARE: EARTHA JEAN JOHNSON

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	320800000X	Mental Illness Community Based Residential Treatment Facility		TX

General Provider Information

NPI Number	:	1871434324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EARTHA JEAN JOHNSON

Provider Business Mailing Address
First Line	:	5606 WHITE BIRCH RUN
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77386-3844
Country	:	US
Telephone Number	:	281-300-8282
Fax Number	:

Provider Business Practice Location Address
First Line	:	5606 WHITE BIRCH RUN
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77386-3844
Country	:	US
Telephone Number	:	281-300-8282
Fax Number	:

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

Provider Enumeration Date	:	04/01/2026
Last Update Date	:	04/01/2026

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