Individual
JOHN DURELL JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RBT
Contact information
Practice address
9480 THREE RIVERS RD, GULFPORT, MS 39503-4248
(228) 313-3106
Mailing address
102 KELLEY CV, PASS CHRISTIAN, MS 39571-2226
(504) 756-9044
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-18-51783
MS
Other
Enumeration date
07/11/2019
Last updated
07/11/2019
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