Provider Demographics
NPI:1033798061
Name:VOSS, JOHNNY RICHARD (BS)
Entity Type:Individual
Prefix:
First Name:JOHNNY
Middle Name:RICHARD
Last Name:VOSS
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 ARMUS ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95776-5417
Mailing Address - Country:US
Mailing Address - Phone:530-302-7325
Mailing Address - Fax:
Practice Address - Street 1:2202 ARMUS ST
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95776-5417
Practice Address - Country:US
Practice Address - Phone:530-302-7325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician