MEDICARE: MRS. CARRIE LYNN JOHNSON MS, NCC, 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	101Y00000X	Counselor
2	101YM0800X	Mental Health Counselor	LMHC17003	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	:	1932541901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CARRIE LYNN JOHNSON MS, NCC, LMHC

Provider Business Mailing Address
First Line	:	1201 BUSINESS WAY, #52
Second Line	:
City	:	LEHIGH ACRES
State	:	FL
Zip	:	33936-9998
Country	:	US
Telephone Number	:	239-312-5352
Fax Number	:	239-230-3029

Provider Business Practice Location Address
First Line	:	6315 PRESIDENTIAL CT STE 120
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-3568
Country	:	US
Telephone Number	:	239-312-5352
Fax Number	:	239-230-3029

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

Provider Enumeration Date	:	07/19/2013
Last Update Date	:	01/21/2020

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