Provider Demographics
NPI:1790548600
Name:JOHNSON, TAZARIAH S
Entity Type:Individual
Prefix:
First Name:TAZARIAH
Middle Name:S
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3855 BLAIR MILL RD APT 246L
Mailing Address - Street 2:
Mailing Address - City:HORSHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19044-2892
Mailing Address - Country:US
Mailing Address - Phone:386-937-7288
Mailing Address - Fax:
Practice Address - Street 1:3855 BLAIR MILL RD APT 246L
Practice Address - Street 2:
Practice Address - City:HORSHAM
Practice Address - State:PA
Practice Address - Zip Code:19044-2892
Practice Address - Country:US
Practice Address - Phone:386-937-7288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health