1083768345 NPI number — CYNTHIA LYNN JOHNSON LCSW LICENESED CLINI

Table of content: CYNTHIA LYNN JOHNSON LCSW LICENESED CLINI (NPI 1083768345)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083768345 NPI number — CYNTHIA LYNN JOHNSON LCSW LICENESED CLINI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
CYNTHIA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW LICENESED CLINI
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SMITH
Provider Other First Name:
CYNTHIA
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1083768345
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/30/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 61
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ADAMSVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38310-0061
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
731-315-1213
Provider Business Mailing Address Fax Number:
731-315-1213

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106 ASH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ADAMSVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38310-4961
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-315-1213
Provider Business Practice Location Address Fax Number:
731-315-1213
Provider Enumeration Date:
01/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LSW0000004454 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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