Healthcare Provider Details

I. General information

NPI: 1548513807
Provider Name (Legal Business Name): JAMES ALLEN JOHNSON JR. M.DIV, CSA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2012
Last Update Date: 10/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10604 E 38TH ST
YUMA AZ
85365-6886
US

IV. Provider business mailing address

10604 E 38TH ST
YUMA AZ
85365-6886
US

V. Phone/Fax

Practice location:
  • Phone: 757-589-0293
  • Fax:
Mailing address:
  • Phone: 757-589-0293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: