Provider Demographics
NPI:1164871828
Name:JONHSON, MARCHE
Entity Type:Individual
Prefix:
First Name:MARCHE
Middle Name:
Last Name:JONHSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3032 WEDEKIND RD
Mailing Address - Street 2:APT 50
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89531
Mailing Address - Country:US
Mailing Address - Phone:775-443-6955
Mailing Address - Fax:
Practice Address - Street 1:3032 WEDEKIND RD
Practice Address - Street 2:APT 50
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89531
Practice Address - Country:US
Practice Address - Phone:775-443-6955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst