Provider Demographics
NPI:1568804714
Name:JOHNSON, TANYA (LMHC, NCC, DCC)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMHC, NCC, DCC
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:
Other - Last Name:WILLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3150 NE 190TH ST
Mailing Address - Street 2:APT 304
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-3129
Mailing Address - Country:US
Mailing Address - Phone:786-505-1145
Mailing Address - Fax:
Practice Address - Street 1:2999 NE 191ST ST
Practice Address - Street 2:SUITE 701
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-3123
Practice Address - Country:US
Practice Address - Phone:786-505-1145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-29
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11793101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health