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General NPI Number Information
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NPI Number | 1417650615
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Entity Type | Individual
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Provider Name | JOHNSON ONI
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Gender | Male
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Dates
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Enumeration Date | 03/24/2023
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Last Update Date | 04/17/2023
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Provider Practice Location Address
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Address Line | 3550 N GOLDENROD RD
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City | WINTER PARK
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State | FL
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Zip | 32792-8823
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Country | US
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Telephone | 407-244-0002
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 916481
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City | LONGWOOD
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State | FL
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Zip | 32791-6481
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Country | US
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Telephone | 407-929-0641
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | IMT3685
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License Number State | FL
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