Provider Demographics
NPI:1942349238
Name:JOHNSON, JEANNIE CATHERINE
Entity Type:Individual
Prefix:
First Name:JEANNIE
Middle Name:CATHERINE
Last Name: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 1:1416 VALLEYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-9269
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1209 HIGHWAY 641 S
Practice Address - Street 2:SUITE A
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-5137
Practice Address - Country:US
Practice Address - Phone:731-641-4141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health