Provider Demographics
NPI:1558571638
Name:JOHNSON, TAMMI J (LMFT, LCADC)
Entity Type:Individual
Prefix:MRS
First Name:TAMMI
Middle Name:J
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMFT, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6112 RIDGECARN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-1372
Mailing Address - Country:US
Mailing Address - Phone:702-561-5605
Mailing Address - Fax:
Practice Address - Street 1:2441 TECH CENTER CT STE 102
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0804
Practice Address - Country:US
Practice Address - Phone:702-518-8061
Practice Address - Fax:702-946-5083
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0859106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist