Individual
TAMATHA L JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LPC
Contact information
Practice address
1600 SKYPARK DR STE 206, MEDFORD, OR 97504-5889
(541) 621-5558
Mailing address
1600 SKYPARK DR STE 206, MEDFORD, OR 97504-5889
(541) 621-5558
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
C3700
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500713320
—
OR
Enumeration date
04/20/2013
Last updated
01/06/2025
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