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General NPI Number Information
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NPI Number | 1194294546
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Entity Type | Individual
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Provider Name | ALLEN KEITH JOHNSON JR. DPC, LPC-S
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Gender | Male
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Dates
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Enumeration Date | 11/15/2018
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Last Update Date | 07/15/2022
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Provider Practice Location Address
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Address Line | 1700 WEST GOVERNMENT STREET BUILDING B. SUITE O.
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City | BRANDON
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State | MS
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Zip | 39042
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Country | US
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Telephone | 601-613-1240
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Fax |
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Provider Business Mailing Address
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Address Line | 1700 W. GOVERNMENT STREET, BUILDING B. SUITE 214
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City | BRANDON
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State | MS
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Zip | 39042
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Country | US
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Telephone | 601-613-1240
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 1864
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License Number State | MS
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