Provider Demographics
NPI:1407074719
Name:JOHNSON, SHANNON E (BA)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:E
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 LINDEN, AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38126
Mailing Address - Country:US
Mailing Address - Phone:901-577-0200
Mailing Address - Fax:901-577-0207
Practice Address - Street 1:427 LINDEN, AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38126
Practice Address - Country:US
Practice Address - Phone:901-577-0200
Practice Address - Fax:901-577-0207
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health