Provider Demographics
NPI:1376931840
Name:JOHNSON, JULIANNE (BCABA)
Entity Type:Individual
Prefix:
First Name:JULIANNE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 N ARCADIA ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-2639
Mailing Address - Country:US
Mailing Address - Phone:720-384-5312
Mailing Address - Fax:719-227-1042
Practice Address - Street 1:1118 N ARCADIA ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-2639
Practice Address - Country:US
Practice Address - Phone:720-384-5312
Practice Address - Fax:719-227-1042
Is Sole Proprietor?:No
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0-14-5916103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst