Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist |
NPI | 1083274757 |
---|---|
Provider Name | Mr. Joseph Garrison Johnson |
First Address | Baton Rouge, LA 70816-3414 |
Second Address | Baton Rouge, LA 70806-7914 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2019 |
Last Update Date | 15/06/2019 |