Provider Demographics
NPI:1467063982
Name:JOHNSON, SCOTT J (LCSW)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:J
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 STATEN ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-7440
Mailing Address - Country:US
Mailing Address - Phone:312-315-2537
Mailing Address - Fax:
Practice Address - Street 1:2375 E TROPICANA AVE # 144
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6564
Practice Address - Country:US
Practice Address - Phone:312-315-2537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1269171041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA224629OtherLICENSE NUMBER