Individual
MRS. AMANDA BETH JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1926 W ELM ST, DURANT, OK 74701-3430
(580) 931-3509
Mailing address
1926 W ELM ST, DURANT, OK 74701-3430
(580) 931-3509
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
10/31/2012
Last updated
10/31/2012
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