Healthcare Provider Details

I. General information

NPI: 1982979266
Provider Name (Legal Business Name): NANCY JANE JOHNSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2012
Last Update Date: 03/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1631-A E. HIGHWAY 66
EL RENO OK
73036
US

IV. Provider business mailing address

8909 OAKMONT CIR
OKLAHOMA CITY OK
73131-7246
US

V. Phone/Fax

Practice location:
  • Phone: 405-422-8405
  • Fax: 405-262-8099
Mailing address:
  • Phone: 405-478-7275
  • Fax: 405-262-8099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1209
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: