Individual
BEVERLY ELAINE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
US HWY 64 OLD HIGH SCHOOL ROAD, SHIPROCK, NM 87420
(505) 368-5163
(505) 368-5502
Mailing address
PO BOX 7454, APT #180, NEWCOMB, NM 87455-7454
(505) 696-3348
(505) 696-3265
Taxonomy
Speciality
Code
Description
License number
State
1041S0200X
School Social Worker
Primary
M-06201
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
70859230
—
NM
Enumeration date
02/28/2007
Last updated
07/08/2007
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