Provider Demographics
NPI:1619463833
Name:JOHNSON, ROXIE (CPC INTERN)
Entity Type:Individual
Prefix:
First Name:ROXIE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CPC INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3606 N RANCHO DR STE 142
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-3130
Mailing Address - Country:US
Mailing Address - Phone:702-778-5300
Mailing Address - Fax:702-778-5301
Practice Address - Street 1:3606 N RANCHO DR STE 142
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-3130
Practice Address - Country:US
Practice Address - Phone:702-778-5300
Practice Address - Fax:702-778-5301
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health