Provider Demographics
NPI:1467764142
Name:JOHNSON, JEWEL E (MED, MS)
Entity Type:Individual
Prefix:MS
First Name:JEWEL
Middle Name:E
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MED, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 NE 20TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73111-2104
Mailing Address - Country:US
Mailing Address - Phone:405-625-4330
Mailing Address - Fax:
Practice Address - Street 1:1102 NE 20TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73111-2104
Practice Address - Country:US
Practice Address - Phone:405-625-4330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-09
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)