Provider Demographics
NPI:1922547108
Name:JOHNSON, DANELLA DENISE (BSBA/BSBM)
Entity Type:Individual
Prefix:
First Name:DANELLA
Middle Name:DENISE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:BSBA/BSBM
Other - Prefix:MISS
Other - First Name:DANELLA
Other - Middle Name:DENISE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:8422 N 123RD EAST AVE
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-2130
Mailing Address - Country:US
Mailing Address - Phone:918-858-4353
Mailing Address - Fax:
Practice Address - Street 1:8422 N 123RD EAST AVE
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-2130
Practice Address - Country:US
Practice Address - Phone:918-858-4353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-21
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK171M00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK101YM0800XMedicaid