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NPI Code Detail

MEDICARE: EVA CHRISTINE JOHNSON RSS

MEDICARE: EVA CHRISTINE JOHNSON RSS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1255604716
Entity Type Code : Individual
Provider Name (Legal Business Name) : EVA CHRISTINE JOHNSON RSS
Provider Business Mailing Address
First Line : 1308 CRADDUCK RD
Second Line :
City : ADA
State : OK
Zip : 74820-8442
Country : US
Telephone Number : 580-332-3699
Fax Number : 580-421-9828
Provider Business Practice Location Address
First Line : 1308 CRADDUCK RD
Second Line :
City : ADA
State : OK
Zip : 74820-8442
Country : US
Telephone Number : 580-332-3699
Fax Number : 580-421-9828
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/14/2012
Last Update Date : 02/14/2012

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Directions to “ EVA CHRISTINE JOHNSON RSS” Practice Location

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