Provider Demographics
NPI:1710253869
Name:KEVIN JOHNSON CLINICAL SERVICES
Entity Type:Organization
Organization Name:KEVIN JOHNSON CLINICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:435-225-4357
Mailing Address - Street 1:3155 S HIDDEN VALLEY DR
Mailing Address - Street 2:#275
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-6671
Mailing Address - Country:US
Mailing Address - Phone:435-225-4357
Mailing Address - Fax:435-674-9380
Practice Address - Street 1:437 S BLUFF ST
Practice Address - Street 2:STE. 202
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3592
Practice Address - Country:US
Practice Address - Phone:435-225-4357
Practice Address - Fax:435-674-9380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-22
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5962642-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty