Provider Demographics
NPI:1417509324
Name:JOHNSON, BRANDON CHER'AWN (LCSW)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:CHER'AWN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 S 11TH ST APT 501
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64503-3143
Mailing Address - Country:US
Mailing Address - Phone:314-828-0332
Mailing Address - Fax:
Practice Address - Street 1:3151 LITTON RD
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:MO
Practice Address - Zip Code:64601-8502
Practice Address - Country:US
Practice Address - Phone:314-828-0332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20170338821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical