MEDICARE: MRS. PHEKILA D JOHNSON MS, LMHC

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	101YM0800X	Mental Health Counselor	IMH10653	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881137941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PHEKILA D JOHNSON MS, LMHC

Provider Business Mailing Address
First Line	:	6408 N ARMENIA AVE STE E-1
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-5770
Country	:	US
Telephone Number	:	813-534-0955
Fax Number	:	813-443-6201

Provider Business Practice Location Address
First Line	:	6408 N ARMENIA AVE STE E-1
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-5770
Country	:	US
Telephone Number	:	813-534-0955
Fax Number	:	813-443-6201

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

Provider Enumeration Date	:	11/22/2016
Last Update Date	:	07/27/2020

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