Individual
JENNIFER JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2612 W DECATUR ST, BROKEN ARROW, OK 74011-6123
(918) 859-8313
Mailing address
2612 W DECATUR ST, BROKEN ARROW, OK 74011-6123
(918) 859-8313
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
02/19/2014
Last updated
02/19/2014
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