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General NPI Number Information
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NPI Number | 1417509324
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Entity Type | Individual
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Provider Name | BRANDON CHER'AWN JOHNSON LCSW
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Gender | Male
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Dates
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Enumeration Date | 07/11/2019
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Last Update Date | 07/11/2019
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Provider Practice Location Address
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Address Line | 3151 LITTON RD
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City | CHILLICOTHEE
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State | MO
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Zip | 64601-8502
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Country | US
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Telephone | 314-828-0332
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Fax |
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Provider Business Mailing Address
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Address Line | 1300 S 11TH ST APT 501
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City | SAINT JOSEPH
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State | MO
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Zip | 64503-3143
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Country | US
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Telephone | 314-828-0332
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2017033882
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License Number State | MO
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