Provider Demographics
NPI:1891115101
Name:COURTNEY-JOHNSON, JO LYNN (M ED)
Entity Type:Individual
Prefix:
First Name:JO
Middle Name:LYNN
Last Name:COURTNEY-JOHNSON
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 W 113TH ST S
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-2161
Mailing Address - Country:US
Mailing Address - Phone:918-851-7694
Mailing Address - Fax:
Practice Address - Street 1:1302 W 113TH ST S
Practice Address - Street 2:
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-2161
Practice Address - Country:US
Practice Address - Phone:918-851-7694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-25
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health