Provider Demographics
NPI:1164943874
Name:COLE-JOHNSON, JO ANN
Entity Type:Individual
Prefix:
First Name:JO
Middle Name:ANN
Last Name:COLE-JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JO
Other - Middle Name:ANN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6505 N SHAWNEE AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-1903
Mailing Address - Country:US
Mailing Address - Phone:408-590-2019
Mailing Address - Fax:
Practice Address - Street 1:6505 N. SHAWNEE AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA
Practice Address - State:OK
Practice Address - Zip Code:73116
Practice Address - Country:US
Practice Address - Phone:408-590-2019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor