Provider Demographics
NPI:1427388313
Name:FREDMAN, JOHNIE DEAN (PSYD, LPC)
Entity Type:Individual
Prefix:DR
First Name:JOHNIE
Middle Name:DEAN
Last Name:FREDMAN
Suffix:
Gender:M
Credentials:PSYD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33007 45TH ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-3429
Mailing Address - Country:US
Mailing Address - Phone:405-214-0116
Mailing Address - Fax:877-334-8552
Practice Address - Street 1:905 E WILSON ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-4165
Practice Address - Country:US
Practice Address - Phone:405-214-0116
Practice Address - Fax:877-334-8552
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-28
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
OK4469101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor