Individual
BRYAN EVANS JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RBT
Contact information
Practice address
3612 JUANITA WAY, NAMPA, ID 83686-8279
(208) 949-5169
Mailing address
3612 JUANITA WAY, NAMPA, ID 83686-8279
(208) 949-5169
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
02/19/2024
Last updated
02/19/2024
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