Provider Demographics
NPI:1437810322
Name:JOHNSON, MATTHEW PHILIP
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:PHILIP
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8050 S PADRE ISLAND DR APT A1
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-5226
Mailing Address - Country:US
Mailing Address - Phone:808-825-5039
Mailing Address - Fax:
Practice Address - Street 1:224 KAMEHAMEHA AVE # 201
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2860
Practice Address - Country:US
Practice Address - Phone:808-825-4214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health