Individual
KENTRELL JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8007 NW 122ND ST, OKLAHOMA CITY, OK 73142-3302
(405) 603-6622
Mailing address
1305 S ARIES RD, EDMOND, OK 73003-5821
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
24359864
OK
Other
Enumeration date
07/26/2024
Last updated
07/26/2024
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