Provider Demographics
NPI:1871661835
Name:JOHNSON, JOSEPH RONALD (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:RONALD
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2945 SHELBY ST
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134-4513
Mailing Address - Country:US
Mailing Address - Phone:901-385-3277
Mailing Address - Fax:901-386-9927
Practice Address - Street 1:2945 SHELBY ST
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-4513
Practice Address - Country:US
Practice Address - Phone:901-385-3277
Practice Address - Fax:901-386-9927
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNCPT0000000021101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral