Provider Demographics
NPI:1073670626
Name:JOHNSON, LUCY T (LCSW)
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:T
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 1:4411 W GORE BLVD STE B8
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-5977
Mailing Address - Country:US
Mailing Address - Phone:580-353-0909
Mailing Address - Fax:580-353-0923
Practice Address - Street 1:4411 W GORE BLVD STE B8
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-5977
Practice Address - Country:US
Practice Address - Phone:580-353-0909
Practice Address - Fax:580-353-0923
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK969101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1073670626OtherNPI
1073670626OtherNPI