Provider Demographics
NPI:1598821126
Name:JOHNSON, JOSEPH MATTHEW
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:MATTHEW
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3720 W WHITEHAWK LN
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-2794
Mailing Address - Country:US
Mailing Address - Phone:480-221-6350
Mailing Address - Fax:623-322-3166
Practice Address - Street 1:3720 W WHITEHAWK LN
Practice Address - Street 2:
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-2794
Practice Address - Country:US
Practice Address - Phone:480-221-6350
Practice Address - Fax:623-322-3166
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10826385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child