Provider Demographics
NPI:1699013052
Name:JOHNSON, KRISTOFER MICHAEL (BA PSYCHOLOGY)
Entity Type:Individual
Prefix:MR
First Name:KRISTOFER
Middle Name:MICHAEL
Last Name:JOHNSON
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Gender:M
Credentials:BA PSYCHOLOGY
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Mailing Address - Street 1:114 W DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:NOWATA
Mailing Address - State:OK
Mailing Address - Zip Code:74048-2601
Mailing Address - Country:US
Mailing Address - Phone:918-273-1841
Mailing Address - Fax:918-273-1843
Practice Address - Street 1:700 S W PENN
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74003-3847
Practice Address - Country:US
Practice Address - Phone:918-337-8080
Practice Address - Fax:918-337-8099
Is Sole Proprietor?:No
Enumeration Date:2013-01-19
Last Update Date:2014-02-11
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health