MEDICARE: CHUCK WILLIAM JOHNSON LCPC, NCC, ACS

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	101YP2500X	Professional Counselor		IL

General Provider Information

NPI Number	:	1952493058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHUCK WILLIAM JOHNSON LCPC, NCC, ACS

Provider Business Mailing Address
First Line	:	2170 HIGHWAY 94 N
Second Line	:
City	:	CAMP POINT
State	:	IL
Zip	:	62320-2516
Country	:	US
Telephone Number	:	217-696-2751
Fax Number	:	217-696-2751

Provider Business Practice Location Address
First Line	:	2170 HIGHWAY 94 N
Second Line	:
City	:	CAMP POINT
State	:	IL
Zip	:	62320-2516
Country	:	US
Telephone Number	:	217-696-2751
Fax Number	:	217-696-2751

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

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	07/08/2007

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