Provider Demographics
NPI:1508236308
Name:JOHNSON, MARIE COOPER (BBA)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:COOPER
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:BBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-5513
Mailing Address - Country:US
Mailing Address - Phone:318-410-1062
Mailing Address - Fax:318-410-1065
Practice Address - Street 1:1010 N 9TH ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201
Practice Address - Country:US
Practice Address - Phone:318-410-1062
Practice Address - Fax:318-410-1065
Is Sole Proprietor?:No
Enumeration Date:2015-10-06
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health