Provider Demographics
NPI:1164134532
Name:JOHNSON, CARL M (TRPC, CPSS, BHT)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:TRPC, CPSS, BHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8523 E LINDNER AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-4375
Mailing Address - Country:US
Mailing Address - Phone:480-740-4976
Mailing Address - Fax:
Practice Address - Street 1:8523 E LINDNER AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-4375
Practice Address - Country:US
Practice Address - Phone:480-740-4976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-16
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty