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General NPI Number Information
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NPI Number | 1992032916
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Entity Type | Individual
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Provider Name | RAYGE LEE JOHNSON BASW
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Gender | Female
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Dates
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Enumeration Date | 11/12/2009
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Last Update Date | 11/12/2009
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Provider Practice Location Address
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Address Line | 900 E MAIN ST BLDG 54W
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City | NORMAN
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State | OK
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Zip | 73071-5305
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Country | US
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Telephone | 405-573-6624
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Fax | 405-573-6656
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Provider Business Mailing Address
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Address Line | PO BOX 151
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City | NORMAN
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State | OK
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Zip | 73070-0151
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Country | US
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Telephone | 405-573-6624
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Fax | 405-573-6656
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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 |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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