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NPI Code Detail

MEDICARE: BRIAN L. JOHNSON MA, LPC

MEDICARE: BRIAN L. JOHNSON MA, LPC
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
1101YP2500XProfessional Counselor3524OK

General Provider Information

NPI Number : 1437475035
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIAN L. JOHNSON MA, LPC
Provider Business Mailing Address
First Line : 1017 NW 6TH STREET
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73106-7202
Country : US
Telephone Number : 405-842-7284
Fax Number : 405-418-0324
Provider Business Practice Location Address
First Line : 1017 NW 6TH STREET
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73106-7202
Country : US
Telephone Number : 405-842-7284
Fax Number : 405-418-0324
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/08/2010
Last Update Date : 08/13/2010

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