Provider Demographics
NPI:1578905444
Name:JOHNSON, RHETT RANDALL (ACMHC)
Entity Type:Individual
Prefix:
First Name:RHETT
Middle Name:RANDALL
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:ACMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2437 E 430 S
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-4740
Mailing Address - Country:US
Mailing Address - Phone:801-602-4128
Mailing Address - Fax:
Practice Address - Street 1:2437 E 430 S
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-4740
Practice Address - Country:US
Practice Address - Phone:801-602-4128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-22
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8728344-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health