Provider Demographics
NPI:1770816738
Name:NGUYEN, JOHNNY P (LMHC)
Entity Type:Individual
Prefix:
First Name:JOHNNY
Middle Name:P
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10002 FOREST HILLS DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-7768
Mailing Address - Country:US
Mailing Address - Phone:813-906-9064
Mailing Address - Fax:
Practice Address - Street 1:10002 FOREST HILLS DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-7768
Practice Address - Country:US
Practice Address - Phone:813-906-9064
Practice Address - Fax:813-462-2912
Is Sole Proprietor?:No
Enumeration Date:2009-09-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH17441101YM0800X, 101YA0400X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH17441OtherSTATE LICENSE
FL104740300Medicaid