Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1053918235 |
---|---|
Provider Name | Carolyn Ann Johnson |
First Address | Tulsa, OK 74108-4710 |
Second Address | Tulsa, OK 74108-4710 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2020 |
Last Update Date | 01/10/2020 |