Provider Demographics
NPI:1346263019
Name:JOHNSON, ELDON LAWRENCE (MED, LPC)
Entity Type:Individual
Prefix:MR
First Name:ELDON
Middle Name:LAWRENCE
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 N 14TH ST
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:OK
Mailing Address - Zip Code:73077-5022
Mailing Address - Country:US
Mailing Address - Phone:918-308-5512
Mailing Address - Fax:
Practice Address - Street 1:502 N 14TH ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:OK
Practice Address - Zip Code:73077-5022
Practice Address - Country:US
Practice Address - Phone:918-308-5512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2587101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional