Provider Demographics
NPI:1447796156
Name:JOHNSON, ERIC JR
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:
Last Name:JOHNSON
Suffix:JR
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 1:114 INEICHEN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:RAYVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71269-3223
Mailing Address - Country:US
Mailing Address - Phone:318-417-7780
Mailing Address - Fax:318-728-1140
Practice Address - Street 1:114 INEICHEN ST
Practice Address - Street 2:SUITE A
Practice Address - City:RAYVILLE
Practice Address - State:LA
Practice Address - Zip Code:71269-3223
Practice Address - Country:US
Practice Address - Phone:318-417-7780
Practice Address - Fax:318-728-1140
Is Sole Proprietor?:No
Enumeration Date:2017-01-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician