MEDICARE: MRS. RENETTA LYNN JOHNSON BHRS

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
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1962772566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RENETTA LYNN JOHNSON BHRS

Provider Business Mailing Address
First Line	:	1525 N MIDWEST BLVD
Second Line	:	APT. 1
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73110-6203
Country	:	US
Telephone Number	:	405-248-1270
Fax Number	:

Provider Business Practice Location Address
First Line	:	1525 N MIDWEST BLVD
Second Line	:	APT. 1
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73110-6203
Country	:	US
Telephone Number	:	405-248-1270
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2012
Last Update Date	:	07/18/2013

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