Provider Demographics
NPI:1275936197
Name:JOHNSON, RICHARD
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7606 PARKER ST
Mailing Address - Street 2:FORT RILEY
Mailing Address - City:JUNCTION CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66442-4247
Mailing Address - Country:US
Mailing Address - Phone:785-240-5814
Mailing Address - Fax:
Practice Address - Street 1:7606 PARKER ST
Practice Address - Street 2:FORT RILEY
Practice Address - City:JUNCTION CITY
Practice Address - State:KS
Practice Address - Zip Code:66442-4247
Practice Address - Country:US
Practice Address - Phone:785-240-5814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-06
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool