Individual
MR. CLYDE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
930 N 14TH ST, NEW CASTLE, IN 47362-4311
(765) 288-1928
(765) 741-0335
Mailing address
240 N TILLOTSON AVE, MUNCIE, IN 47304-3988
(765) 288-1928
(765) 741-0335
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
34006487A
IN
Other
Enumeration date
01/25/2011
Last updated
09/20/2012
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