Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1205266335 |
---|---|
Provider Name | Constance Nevlin Johnson |
First Address | Oklahoma City, OK 73121-2225 |
Second Address | Edmond, OK 73013-4038 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2013 |
Last Update Date | 27/11/2013 |