Provider Demographics
NPI:1033868088
Name:JOHNSON, SHARRELL (LCSW)
Entity Type:Individual
Prefix:
First Name:SHARRELL
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 W I 240 SERVICE ROAD
Mailing Address - Street 2:1166
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-1735
Mailing Address - Country:US
Mailing Address - Phone:405-593-8686
Mailing Address - Fax:
Practice Address - Street 1:6012 SE 67TH STREET
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73135-1735
Practice Address - Country:US
Practice Address - Phone:405-593-8686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-18
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty