Provider Demographics
NPI:1295272060
Name:JOHNSON, JOHNNY MARIE
Entity type:Individual
Prefix:MS
First Name:JOHNNY
Middle Name:MARIE
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 1:910 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:MO
Mailing Address - Zip Code:63933-1304
Mailing Address - Country:US
Mailing Address - Phone:573-922-0709
Mailing Address - Fax:
Practice Address - Street 1:925 HWY VV FAMILY COUNSELING CENTER
Practice Address - Street 2:
Practice Address - City:KENNETT
Practice Address - State:MO
Practice Address - Zip Code:63857
Practice Address - Country:US
Practice Address - Phone:573-888-9365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator