Provider Demographics
NPI:1821641580
Name:JOHNSON, RUTH ELENA
Entity Type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:ELENA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:RUTH
Other - Middle Name:ELENA
Other - Last Name:HAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4820 GRACE CT
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-8635
Mailing Address - Country:US
Mailing Address - Phone:775-354-5226
Mailing Address - Fax:
Practice Address - Street 1:6490 S MCCARRAN BLVD UNIT 21
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6165
Practice Address - Country:US
Practice Address - Phone:775-825-7500
Practice Address - Fax:775-825-7550
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst