Organization
INTERACTION COUNSELING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JIM JOHNSON LCSW (SOCIAL WORKER)
(580) 353-0909
Entity
Organization
Contact information
Practice address
4411 W GORE BLVD STE B10, LAWTON, OK 73505-5977
(580) 353-0909
Mailing address
4411 W GORE BLVD STE B10, LAWTON, OK 73505-5977
(580) 353-0909
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
36
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
500522083
MEDICARE GROUP IDENTIFIER
OK
Enumeration date
01/08/2008
Last updated
03/06/2008
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