Individual
MRS. TANYA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6824 S 68TH DR, LAVEEN, AZ 85339-5013
(602) 237-8782
Mailing address
6824 S 68TH DR, LAVEEN, AZ 85339-5013
(602) 237-8782
Taxonomy
Speciality
Code
Description
License number
State
385HR2055X
Child Mental Illness Respite Care
Primary
673139
AZ
Other
Enumeration date
06/26/2008
Last updated
06/26/2008
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