Provider Demographics
NPI:1972294882
Name:JOHNSON, WILLIAM TYLER
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:TYLER
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12320 ROUTE 30 STE 11
Mailing Address - Street 2:
Mailing Address - City:NORTH HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:15642-2590
Mailing Address - Country:US
Mailing Address - Phone:412-877-8011
Mailing Address - Fax:
Practice Address - Street 1:12320 ROUTE 30 STE 11
Practice Address - Street 2:
Practice Address - City:NORTH HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:15642-2590
Practice Address - Country:US
Practice Address - Phone:412-877-8011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health