Individual
MR. QUINTRELL DESHAUN JOHNSON SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3621 N KELLEY AVE, SUITE 100, OKLAHOMA CITY, OK 73111-4520
(405) 524-5525
Mailing address
3213 NW 43RD ST, OKLAHOMA CITY, OK 73112-6247
(405) 639-7979
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
OK
Other
Enumeration date
07/08/2011
Last updated
07/08/2011
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