Provider Demographics
NPI:1184034902
Name:JOHNSON, ORLANDO III
Entity Type:Individual
Prefix:
First Name:ORLANDO
Middle Name:
Last Name:JOHNSON
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ORLANDO
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:BSOE
Mailing Address - Street 1:11229 N PENNSYLVANIA AVE
Mailing Address - Street 2:531
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-7739
Mailing Address - Country:US
Mailing Address - Phone:405-759-0532
Mailing Address - Fax:
Practice Address - Street 1:11229 N PENNSYLVANIA AVE
Practice Address - Street 2:531
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-7739
Practice Address - Country:US
Practice Address - Phone:405-759-0532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-01
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator