Healthcare Provider Details

I. General information

NPI: 1922547108
Provider Name (Legal Business Name): DANELLA DENISE JOHNSON BSBA/BSBM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DANELLA DENISE JOHNSON LPC

II. Dates (important events)

Enumeration Date: 02/21/2017
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8422 N 123RD EAST AVE
OWASSO OK
74055-2130
US

IV. Provider business mailing address

8422 N 123RD EAST AVE
OWASSO OK
74055-2130
US

V. Phone/Fax

Practice location:
  • Phone: 918-858-4353
  • Fax:
Mailing address:
  • Phone: 918-858-4353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: