Provider Demographics
NPI:1578108841
Name:JOHNSON, KLAITON MARKELL
Entity Type:Individual
Prefix:
First Name:KLAITON
Middle Name:MARKELL
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 W CHEYENNE AVE STE 40
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-7849
Mailing Address - Country:US
Mailing Address - Phone:702-633-7923
Mailing Address - Fax:702-633-7610
Practice Address - Street 1:730 W CHEYENNE AVE STE 40
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-7849
Practice Address - Country:US
Practice Address - Phone:702-633-7923
Practice Address - Fax:702-633-7610
Is Sole Proprietor?:No
Enumeration Date:2019-11-11
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician