Organization
DERIVATIVE PSYCHIATRY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAKE HENRY JOHNSON MD (CEO & FOUNDER)
(480) 290-4385
Entity
Organization
Contact information
Practice address
3750 W MAIN ST STE AA, NORMAN, OK 73072-4645
(405) 928-9438
Mailing address
3750 W MAIN ST STE AA, NORMAN, OK 73072-4645
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Enumeration date
07/17/2025
Last updated
07/17/2025
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