Healthcare Provider Details

I. General information

NPI: 1568736262
Provider Name (Legal Business Name): BRANON JOHNSON LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2012
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 E 680 S
CEDAR CITY UT
84720-3593
US

IV. Provider business mailing address

474 W 200 N STE 300
ST GEORGE UT
84770-4505
US

V. Phone/Fax

Practice location:
  • Phone: 435-867-7654
  • Fax:
Mailing address:
  • Phone: 435-634-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5576511-6004
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5576511-6004
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: