Individual
TYRONE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
906 N 1ST ST, GRANTS, NM 87020-2806
(505) 287-7985
Mailing address
282 S CAMINO DEL PUEBLO STE C, BERNALILLO, NM 87004-5909
(505) 288-3897
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
M 07953
NM
Other
Enumeration date
04/28/2014
Last updated
04/28/2014
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