Provider Demographics
NPI:1326533878
Name:JOHNSON, KELCEY (CESP, MAR)
Entity Type:Individual
Prefix:
First Name:KELCEY
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:CESP, MAR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-2203
Mailing Address - Country:US
Mailing Address - Phone:901-502-9759
Mailing Address - Fax:901-763-1869
Practice Address - Street 1:82 N 2ND ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-2203
Practice Address - Country:US
Practice Address - Phone:901-502-9759
Practice Address - Fax:901-763-1869
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator