MEDICARE: MARION JOYCE 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	101Y00000X	Counselor
2	101YM0800X	Mental Health Counselor	96175	CA

General Provider Information

NPI Number	:	1962790451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARION JOYCE JOHNSON

Provider Business Mailing Address
First Line	:	6620 VIA DEL ORO
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95119-1392
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6620 VIA DEL ORO
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95119-1392
Country	:	US
Telephone Number	:	408-360-2300
Fax Number	:

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

Provider Enumeration Date	:	07/18/2011
Last Update Date	:	01/03/2022

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Directions to “ MARION JOYCE JOHNSON ” Practice Location

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