Provider Demographics
NPI:1760192082
Name:JOHNSON, NATASHA EILEEN (MA, COBA)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:EILEEN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA, COBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 S BEECH ST
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:OH
Mailing Address - Zip Code:43506-1602
Mailing Address - Country:US
Mailing Address - Phone:419-633-3333
Mailing Address - Fax:419-754-2255
Practice Address - Street 1:113 S BEECH ST
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:OH
Practice Address - Zip Code:43506-1602
Practice Address - Country:US
Practice Address - Phone:419-633-3333
Practice Address - Fax:419-754-2255
Is Sole Proprietor?:No
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOBA.00595103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst