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General NPI Number Information
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NPI Number | 1487905436
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Entity Type | Individual
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Provider Name | TRINA LACHELLE JOHNSON M.A., LMFT
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Gender | Female
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Dates
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Enumeration Date | 09/28/2012
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Last Update Date | 05/20/2016
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Provider Practice Location Address
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Address Line | 3838 NW 36TH ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112-2970
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Country | US
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Telephone | 405-227-0253
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Fax |
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Provider Business Mailing Address
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Address Line | 3838 NW 36TH ST SUITE 200
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112-2970
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Country | US
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Telephone | 405-673-3972
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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 | 1183
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License Number State | OK
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