Provider Demographics
NPI:1558633362
Name:DEBORAH K. JOHNSON & ASSOCIATES PC
Entity Type:Organization
Organization Name:DEBORAH K. JOHNSON & ASSOCIATES PC
Other - Org Name:CENTER FOR MIND&BODY WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:K
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, APRN, CNS
Authorized Official - Phone:701-852-3550
Mailing Address - Street 1:1015 S BROADWAY
Mailing Address - Street 2:STE 37
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-4667
Mailing Address - Country:US
Mailing Address - Phone:701-852-3550
Mailing Address - Fax:701-852-2645
Practice Address - Street 1:1015 S. BROADWAY
Practice Address - Street 2:STE 37
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-4667
Practice Address - Country:US
Practice Address - Phone:701-852-3550
Practice Address - Fax:701-852-2645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR15247251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDN4614Medicare UPIN