Provider Demographics
NPI:1871837740
Name:FRIIS JOHNSON, ROBIN G
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:G
Last Name:FRIIS JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2190 W 2300 S
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:UT
Mailing Address - Zip Code:84075-9362
Mailing Address - Country:US
Mailing Address - Phone:801-885-0836
Mailing Address - Fax:
Practice Address - Street 1:1387 W 1800 N
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:UT
Practice Address - Zip Code:84015-8942
Practice Address - Country:US
Practice Address - Phone:801-779-0095
Practice Address - Fax:801-779-0255
Is Sole Proprietor?:No
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health