Provider Demographics
NPI:1174943880
Name:JOHNSON, BRANDY
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:BRANDY
Other - Middle Name:
Other - Last Name:NICKELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6632 PEACHTREE LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-4328
Mailing Address - Country:US
Mailing Address - Phone:702-768-3257
Mailing Address - Fax:
Practice Address - Street 1:8871 W FLAMINGO RD
Practice Address - Street 2:STE 105A
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-8757
Practice Address - Country:US
Practice Address - Phone:702-586-5001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst