Provider Demographics
NPI:1235884743
Name:JOHNSON, TASHALA (QMHS)
Entity Type:Individual
Prefix:
First Name:TASHALA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:QMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 W SOUTH BOUNDARY ST
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-5102
Mailing Address - Country:US
Mailing Address - Phone:419-388-4479
Mailing Address - Fax:
Practice Address - Street 1:118 W SOUTH BOUNDARY ST
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-5102
Practice Address - Country:US
Practice Address - Phone:419-388-4479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator