Provider Demographics
NPI:1063603439
Name:JOHNSON, BETTE
Entity type:Individual
Prefix:MRS
First Name:BETTE
Middle Name:
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:PO BOX 337
Mailing Address - Street 2:
Mailing Address - City:KAYENTA
Mailing Address - State:AZ
Mailing Address - Zip Code:86033
Mailing Address - Country:US
Mailing Address - Phone:928-697-2051
Mailing Address - Fax:928-697-2095
Practice Address - Street 1:NORTH HWY 160
Practice Address - Street 2:KAYENTA UNIFIED SCHOOL DISTRICT
Practice Address - City:KAYENTA
Practice Address - State:AZ
Practice Address - Zip Code:86033
Practice Address - Country:US
Practice Address - Phone:928-697-2051
Practice Address - Fax:928-697-2095
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool