Provider Demographics
NPI:1619625894
Name:JOHNSON, MICHAEL G
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:G
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 1:7116 S COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-5519
Mailing Address - Country:US
Mailing Address - Phone:918-510-4094
Mailing Address - Fax:
Practice Address - Street 1:OKLAHOMA CHRISTIAN COUNSELING
Practice Address - Street 2:1704 S. UTICA AVE
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104
Practice Address - Country:US
Practice Address - Phone:918-319-2935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional