MEDICARE: AMANDA G JOHNSON, LPC

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	251S00000X	Community/Behavioral Health Agency	67244	TX

General Provider Information

NPI Number	:	1992249304
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMANDA G JOHNSON, LPC

Provider Business Mailing Address
First Line	:	98 CHAPEL CT
Second Line	:
City	:	WHITESBORO
State	:	TX
Zip	:	76273-5746
Country	:	US
Telephone Number	:	817-944-0221
Fax Number	:

Provider Business Practice Location Address
First Line	:	98 CHAPEL CT
Second Line	:
City	:	WHITESBORO
State	:	TX
Zip	:	76273-5746
Country	:	US
Telephone Number	:	817-944-0221
Fax Number	:

Authorized Official
Title or Position	:	LICENSED PROFESSIONAL COUNSELOR
Name	:	AMANDA G JOHNSON
Credential	:	M.A.
Telephone Number	:	817-944-0221

Provider Enumeration Date	:	12/05/2016
Last Update Date	:	12/05/2016

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