Provider Demographics
NPI:1215219589
Name:JOHNSON, ROBERT LAURAN (BCBA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:LAURAN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 57
Mailing Address - Street 2:
Mailing Address - City:DEETH
Mailing Address - State:NV
Mailing Address - Zip Code:89823-0057
Mailing Address - Country:US
Mailing Address - Phone:775-340-5943
Mailing Address - Fax:
Practice Address - Street 1:1900 DENNIS FLAT ROAD
Practice Address - Street 2:
Practice Address - City:DEETH
Practice Address - State:NV
Practice Address - Zip Code:89823-0057
Practice Address - Country:US
Practice Address - Phone:775-340-5943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLBAT042222103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVLBAT042222OtherSTATE LICENSE