Provider Demographics
NPI:1689941510
Name:JOHNSON, REGINALD (BHRS)
Entity Type:Individual
Prefix:
First Name:REGINALD
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14203 BRANGUS RD
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-3330
Mailing Address - Country:US
Mailing Address - Phone:405-275-2619
Mailing Address - Fax:
Practice Address - Street 1:14203 BRANGUS RD
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-3330
Practice Address - Country:US
Practice Address - Phone:405-275-2619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health