Provider Demographics
NPI:1902180524
Name:ROBERT JOHNSON
Entity Type:Organization
Organization Name:ROBERT JOHNSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LAURAN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:775-752-3695
Mailing Address - Street 1:57 STARR VALLEY STREET
Mailing Address - Street 2:
Mailing Address - City:DEETH
Mailing Address - State:NV
Mailing Address - Zip Code:89823
Mailing Address - Country:US
Mailing Address - Phone:775-752-3695
Mailing Address - Fax:
Practice Address - Street 1:57 STARR VALLEY STREET
Practice Address - Street 2:
Practice Address - City:DEETH
Practice Address - State:NV
Practice Address - Zip Code:89823
Practice Address - Country:US
Practice Address - Phone:775-752-3695
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLBAT042222103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty