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General NPI Number Information
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NPI Number | 1003079369
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Entity Type | Organization
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Legal Business Name | SHAWN JOHNSON, PH.D., LLC
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Dates
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Enumeration Date | 07/08/2008
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Last Update Date | 07/08/2008
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Provider Practice Location Address
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Address Line | 4111 OKEMOS RD STE 104
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City | OKEMOS
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State | MI
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Zip | 48864-3235
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Country | US
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Telephone | 517-347-4755
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Fax |
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Provider Business Mailing Address
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Address Line | 4111 OKEMOS RD STE 104
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City | OKEMOS
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State | MI
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Zip | 48864-3235
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Country | US
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Telephone | 517-347-4755
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHAWN JOHNSON
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Credential | PH.D.
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Telephone | 517-347-4755
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 4101006045
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License Number State | MI
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