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NPI Code Detail

MEDICARE: TANEKA RENEE JOHNSON

MEDICARE: TANEKA RENEE JOHNSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1801228341
Entity Type Code : Individual
Provider Name (Legal Business Name) : TANEKA RENEE JOHNSON
Provider Business Mailing Address
First Line : 124 BRADFORD PL
Second Line :
City : MIDWEST CITY
State : OK
Zip : 73130-3541
Country : US
Telephone Number : 405-869-7158
Fax Number :
Provider Business Practice Location Address
First Line : 2808 NW 31ST ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73112-7407
Country : US
Telephone Number : 405-885-5962
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/07/2013
Last Update Date : 08/07/2013

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Directions to “ TANEKA RENEE JOHNSON ” Practice Location

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