Provider Demographics
NPI:1518504356
Name:JOHNSON, LEXUS JADE (BCBA, LBA, MS)
Entity Type:Individual
Prefix:MRS
First Name:LEXUS
Middle Name:JADE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:BCBA, LBA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:268 S 740 W
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-2530
Mailing Address - Country:US
Mailing Address - Phone:763-381-1676
Mailing Address - Fax:
Practice Address - Street 1:1159 E 200 N STE 100
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2053
Practice Address - Country:US
Practice Address - Phone:801-935-4171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-27
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
UT13735245-2506103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician