Individual
LANCE CORDELL JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7908 NW 23RD ST, BETHANY, OK 73008-4950
(405) 636-1463
Mailing address
7508 S LINN AVE, OKLAHOMA CITY, OK 73159-4612
(405) 443-1481
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
02/09/2012
Last updated
02/09/2012
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