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General NPI Number Information
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NPI Number | 1417389719
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Entity Type | Individual
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Provider Name | NICOLE LAFAYE JOHNSON LPC
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Gender | Female
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Dates
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Enumeration Date | 08/08/2013
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Last Update Date | 08/08/2013
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Provider Practice Location Address
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Address Line | 2520 NW 39TH TER
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112-3730
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Country | US
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Telephone | 405-881-7853
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Fax |
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Provider Business Mailing Address
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Address Line | 13609 INVERNESS AVE
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City | OKLAHOMA CITY
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State | OK
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Zip | 73120-8529
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Country | US
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Telephone | 405-881-7853
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 4589
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License Number State |
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