Provider Demographics
NPI:1710391149
Name:JOHNSON, NOAH NATHANIEL
Entity Type:Individual
Prefix:MR
First Name:NOAH
Middle Name:NATHANIEL
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 1:109 PARMAC RD
Mailing Address - Street 2:STE. 1
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-2294
Mailing Address - Country:US
Mailing Address - Phone:530-891-2986
Mailing Address - Fax:530-879-3823
Practice Address - Street 1:109 PARMAC RD
Practice Address - Street 2:STE. 1
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2294
Practice Address - Country:US
Practice Address - Phone:530-891-2986
Practice Address - Fax:530-879-3823
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health